Basic Information
| Provider Information | |||||||||
| NPI: | 1376206821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OAKES | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16501 N AMTRUST ST APT 202 | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836875294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412163390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3649 N LAKEHARBOR LN | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837036913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089914296 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2021 | ||||||||
| LastUpdateDate: | 10/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 40148 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.