Provider Demographics
NPI:1376255893
Name:NATALEE R MITROVICH INC
Entity Type:Organization
Organization Name:NATALEE R MITROVICH INC
Other - Org Name:NATALEE MITROVICH, MA, LCPC
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:NATALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LCPC
Authorized Official - Phone:224-818-4432
Mailing Address - Street 1:109 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-1825
Mailing Address - Country:US
Mailing Address - Phone:224-818-4432
Mailing Address - Fax:
Practice Address - Street 1:109 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1825
Practice Address - Country:US
Practice Address - Phone:224-818-4432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty