Provider Demographics
NPI:1285716159
Name:MITCHELL, JODY BETH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:BETH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 STEAMBOAT CT
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-9571
Mailing Address - Country:US
Mailing Address - Phone:815-313-5721
Mailing Address - Fax:
Practice Address - Street 1:1520 N ROCK RUN DR
Practice Address - Street 2:SUITE 30A
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-3153
Practice Address - Country:US
Practice Address - Phone:815-741-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional