Most Relevant Information
Provider Data
| NPI Number: | 1003447145 |
| Provider Name: | LARAE MITCHELL |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/28/2020 |
| Last Updated: | 01/28/2020 |
Provider Practice Location
6013 S REDWOOD RD
TAYLORSVILLE
UT
841235220
Practice Location Phone/Fax
| Phone: | 8012555131 |
| Fax: |
Provider Mailing Location
6013 S REDWOOD RD
TAYLORSVILLE
UT
841235220
Provider Mailing Phone/Fax
| Phone: | 8012555131 |
| Fax: |