Provider Demographics
NPI:1609402874
Name:MITCHAM, ANTHONY PATRICK
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PATRICK
Last Name:MITCHAM
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 1:552 E NICHOLS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2838
Mailing Address - Country:US
Mailing Address - Phone:360-798-4717
Mailing Address - Fax:
Practice Address - Street 1:3155 SNOW TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9204
Practice Address - Country:US
Practice Address - Phone:720-295-3790
Practice Address - Fax:877-400-4480
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician