| Doctor Name: | MRS. JODY BETH MITCHELL |
| NPI Number: | 1285716159 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | |
| Business Practice Address: | 1520 N Rock Run Dr Suite 30a Crest Hill, IL - 604353153 |
| Business Phone Number: | 8157413009 |
| Business Fax Number: | |
| Mailing Address: | 708 Steamboat Ct, OTTAWA |
| State: | IL |
| Postal Code: | 613509571 |
| Phone Number: | 8153135721 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |