Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 2014000839 | MO |
NPI | 1003034901 |
---|---|
Provider Name | Shannon J Mitchell |
First Address | Lake St Louis, MO 63367-1230 |
Second Address | Lake St Louis, MO 63367-1230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 16/01/2014 |