Healthcare Provider Details

I. General information

NPI: 1184084139
Provider Name (Legal Business Name): MITCHELL RYAN POWERS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E WOODFIELD ROAD SUITE 1000
SCHAUMBURG IL
60173-5113
US

IV. Provider business mailing address

1701 E WOODFIELD ROAD SUITE 1000
SCHAUMBURG IL
60173-5113
US

V. Phone/Fax

Practice location:
  • Phone: 847-240-2211
  • Fax: 847-240-2418
Mailing address:
  • Phone: 847-240-2211
  • Fax: 847-240-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009821
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: