Active NPI
Shannon J Mitchell
- Behavior Analyst
- Lake St Louis, MO
National Provider Identifier
1003034901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 2014000839
- Practice address
- 10 Chartres CT
Lake St Louis, MO 63367-1230 - Phone
- (618) 322-8746
- NPI assigned
- Apr 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 2014000839 | MO | Primary |
Addresses
Primary practice location
10 Chartres CT
Lake St Louis, MO 63367-1230
Mailing address
10 Chartres CT
Lake St Louis, MO 63367-1230
Phone (618) 322-8746
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014000839 | MO | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389830400000",
"number": "1003034901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CHARTRES CT",
"city": "LAKE ST LOUIS",
"state": "MO",
"postal_code": "633671230",
"telephone_number": "618-322-8746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CHARTRES CT",
"city": "LAKE ST LOUIS",
"state": "MO",
"postal_code": "633671230",
"telephone_number": "618-322-8746"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "SHANNON",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-23",
"last_updated": "2014-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MO",
"license": "2014000839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake St Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.