Provider Demographics
NPI:1902350200
Name:MITCHELL, ANDREA (RBT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 N WEBER ST APT D
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4357
Mailing Address - Country:US
Mailing Address - Phone:719-359-1688
Mailing Address - Fax:
Practice Address - Street 1:4302 N WEBER ST APT D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4357
Practice Address - Country:US
Practice Address - Phone:719-359-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CO16-22927106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician