Provider Demographics
NPI:1891816328
Name:MITCHELL, KARYN (ND, PHD, LMT)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ND, PHD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2018
Mailing Address - Country:US
Mailing Address - Phone:815-732-7150
Mailing Address - Fax:630-443-9930
Practice Address - Street 1:603 GENEVA RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-4201
Practice Address - Country:US
Practice Address - Phone:815-732-7150
Practice Address - Fax:630-443-9930
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 175F00000X
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered174400000XOther Service ProvidersSpecialist