Provider Demographics
NPI:1447727227
Name:MITCHELL, MICHAEL BEN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BEN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 VETERANS HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGSQ
Mailing Address - State:CO
Mailing Address - Zip Code:80904
Mailing Address - Country:US
Mailing Address - Phone:719-568-2838
Mailing Address - Fax:
Practice Address - Street 1:6071 E WOODMEN RD STE 320
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2612
Practice Address - Country:US
Practice Address - Phone:719-571-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONCL0004839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health