Individual
JENNIFER MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D, BCBA-D
Contact information
Practice address
5242 S 4820 W, KEARNS, UT 84118-6422
(801) 966-4251
(801) 966-4289
Mailing address
350 S 400 E, SALT LAKE CITY, UT 84111-2908
(801) 582-5534
(801) 582-5540
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
8431995-2506
UT
103TC0700X
Clinical Psychologist
Primary
8431995-2501
UT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/10/2011
Last updated
10/15/2015
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