Provider Demographics
NPI:1295853539
Name:MITCHELL, BETHANY JANE (MA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JANE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 N MALDEN ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6714
Mailing Address - Country:US
Mailing Address - Phone:847-529-9159
Mailing Address - Fax:
Practice Address - Street 1:3375 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE F
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7701
Practice Address - Country:US
Practice Address - Phone:847-577-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional