Provider Demographics
NPI:1043669096
Name:MITCHELL, LANDER
Entity type:Individual
Prefix:
First Name:LANDER
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88732
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98138-2732
Mailing Address - Country:US
Mailing Address - Phone:206-693-9202
Mailing Address - Fax:206-901-2210
Practice Address - Street 1:14900 INTERURBAN AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4635
Practice Address - Country:US
Practice Address - Phone:206-693-9202
Practice Address - Fax:206-248-1160
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 225C00000X, 101YP2500X
IN225C00000X
WA60605156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No171400000XOther Service ProvidersHealth & Wellness Coach
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional