Provider Demographics
NPI:1932414026
Name:MITICH, ASHLEY RAE (EDD, LCPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RAE
Last Name:MITICH
Suffix:
Gender:F
Credentials:EDD, LCPC, NCC
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:RAE
Other - Last Name:COSENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15004 S. BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:815-325-3628
Mailing Address - Fax:708-226-0040
Practice Address - Street 1:15915 CRYSTAL CREEK DR
Practice Address - Street 2:SUITE C
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491
Practice Address - Country:US
Practice Address - Phone:708-529-6976
Practice Address - Fax:708-226-0010
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010649101Y00000X, 101YP2500X
IL178.006788101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622805OtherBCBS PROVIDER NUMBER
IL1622805OtherBCBS PROVIDER NUMBER