Provider Demographics
NPI:1861788820
Name:MITCHELL, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 FRIENDLY STREET
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:575-644-6355
Mailing Address - Fax:
Practice Address - Street 1:2898 FRIENDLY STREET
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:575-644-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR408496225X00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst