Active NPI
Jeremiah Mitchell Jr.
- Mental Health Counselor
- Las Vegas, NV
National Provider Identifier
1366867657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2600020087
- Practice address
- 8001 Kentshire Dr
Las Vegas, NV 89117-3927 - Phone
- (213) 640-7174
- NPI assigned
- Feb 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2600020087 | NV | Primary |
| Community Health Worker | 172V00000X | 2600020087 | NV |
Addresses
Primary practice location
8001 Kentshire Dr
Las Vegas, NV 89117-3927
Mailing address
8001 Kentshire Dr
Las Vegas, NV 89117-3927
Phone (213) 640-7174
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1129 | Medicaid | NV | |
| 1017 | Medicaid | NV | |
| 1023 | Medicaid | NV | |
| 0101 | Medicaid | NV |
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 |
|---|---|---|---|
| 2600020087 | NV | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393200000000",
"number": "1366867657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8001 KENTSHIRE DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891173927",
"telephone_number": "213-640-7174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8001 KENTSHIRE DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891173927",
"telephone_number": "213-640-7174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "JEREMIAH",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-24",
"last_updated": "2014-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NV",
"license": "2600020087",
"primary": true
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NV",
"license": "2600020087",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1129",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1017",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1023",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0101",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.