Provider Demographics
NPI:1114898137
Name:MITCHELL, KRISTY LEE (CADC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:CHERRY
Mailing Address - State:IL
Mailing Address - Zip Code:61317-0309
Mailing Address - Country:US
Mailing Address - Phone:815-481-1799
Mailing Address - Fax:
Practice Address - Street 1:14 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CHERRY
Practice Address - State:IL
Practice Address - Zip Code:61317-1066
Practice Address - Country:US
Practice Address - Phone:815-481-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33539101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)