Healthcare Provider Details

I. General information

NPI: 1366148108
Provider Name (Legal Business Name): LATASHA N MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHA NICHOLE MITCHELL

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 S HARLEM AVE STE G
BRIDGEVIEW IL
60455-1775
US

IV. Provider business mailing address

8550 S HARLEM AVE STE G
BRIDGEVIEW IL
60455-1775
US

V. Phone/Fax

Practice location:
  • Phone: 773-234-9513
  • Fax:
Mailing address:
  • Phone: 630-387-9305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: