Healthcare Provider Details

I. General information

NPI: 1619857737
Provider Name (Legal Business Name): LORI MITCHELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 CEDAR AVE
LAKE VILLA IL
60046-8411
US

IV. Provider business mailing address

347 ASPEN POINTE RD
VERNON HILLS IL
60061-2349
US

V. Phone/Fax

Practice location:
  • Phone: 847-265-7300
  • Fax: 847-265-7301
Mailing address:
  • Phone: 847-265-7300
  • Fax: 847-265-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178021872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: