| Jonathan Mitchell, Llc | |
|
3175 Custer Dr Ste 303 Lexington KY 40517-4023 | |
| (859) 312-4484 | |
| Not Available |
| Full Name | Jonathan Mitchell, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3175 Custer Dr Ste 303, Lexington, Kentucky |
| Authorized Official Name and Position | Jonathan Mitchell (OWNER) |
| Authorized Official Contact | 8593124484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan Mitchell, Llc 3175 Custer Dr Ste 303 Lexington KY 40517-4023 Ph: (859) 312-4484 | Jonathan Mitchell, Llc 3175 Custer Dr Ste 303 Lexington KY 40517-4023 Ph: (859) 312-4484 |
| NPI Number | 1689205809 |
|---|---|
| Provider Enumeration Date | 01/27/2020 |
| Last Update Date | 03/18/2024 |
| Certification Date | 03/18/2024 |
| Medicare PECOS PAC ID | 5395181424 |
|---|---|
| Medicare Enrollment ID | O20240312002589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689205809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jonathan Mitchell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710431671 PECOS PAC ID: 2264883099 Enrollment ID: I20240320003878 |
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