Provider Demographics
NPI:1992523880
Name:MITCHELL, TERROR
Entity type:Individual
Prefix:
First Name:TERROR
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1010
Mailing Address - Country:US
Mailing Address - Phone:380-258-6878
Mailing Address - Fax:
Practice Address - Street 1:1333 S MAYFLOWER AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4066
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:888-588-2752
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant