Provider Demographics
NPI:1477246601
Name:MITCHELL, LAVETTA M
Entity Type:Individual
Prefix:MS
First Name:LAVETTA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LIONS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3175
Mailing Address - Country:US
Mailing Address - Phone:224-655-2655
Mailing Address - Fax:
Practice Address - Street 1:111 LIONS DR STE 201
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3175
Practice Address - Country:US
Practice Address - Phone:224-655-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019064101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional