Basic Information
| Provider Information | |||||||||
| NPI: | 1194278119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | DEJALYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 S BROAD ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043099991 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 S BROAD ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043099991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2016 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.