Provider Demographics
NPI:1699165118
Name:MITCHELL, EVAN LEIGH (MSW)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:LEIGH
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2284
Mailing Address - Country:US
Mailing Address - Phone:816-518-0189
Mailing Address - Fax:816-508-6255
Practice Address - Street 1:1000 E 24TH ST STE 2E
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2776
Practice Address - Country:US
Practice Address - Phone:816-404-5850
Practice Address - Fax:816-404-6049
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9461104100000X
MO2015002882104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490019801Medicaid