Jaclyn Mixell

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2025025003 Issued in MO

Practice address

1612 S Big Bend Blvd
Saint Louis, MO 63117-2208

Phone

(314) 529-1391

NPI assigned

Oct 2, 2025

Last updated

Oct 2, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Avenues Counseling Center

  dba Avenues Counseling Cetner

  • Mental Health Counselor
  • Saint Louis, MO
  • NPI 1568883585
  NPD (past)
• Avenues Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ferguson, MO
  • NPI 1669354445
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1759363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1114891025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 S BIG BEND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631172208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 S BIG BEND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631172208",
            "telephone_number": "314-529-1391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "409 S Florissant Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Ferguson",
            "state": "MO",
            "postal_code": "631352894",
            "country_code": "US",
            "telephone_number": "314-529-1391",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIXELL",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-02",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2025025003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Christine Mittler, PMHNP
• Lane Mittler
• Laura Mittler, MA, RD, LD
• Marina Mityul, M.D.
• Victoria Mityul, MD
• Blake Miyamoto, MD
• Morio Miyamoto, O.D.
• Kana Miyata
• Jonathan Mizrahi, M.D.
• Yuima Mizutani, M.ED., NCC, LPC

• Professional Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.