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Individual

JEREMIAH MITCHELL JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
8001 KENTSHIRE DR, LAS VEGAS, NV 89117-3927
(213) 640-7174
Mailing address
8001 KENTSHIRE DR, LAS VEGAS, NV 89117-3927
(213) 640-7174

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2600020087
NV
172V00000X
Community Health Worker
2600020087
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0101
NV
05
1017
NV
05
1023
NV
05
1129
NV
Enumeration date
02/24/2014
Last updated
02/24/2014
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