Individual
MRS. ASHLEY RAE MITICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD, LCPC, NCC
Contact information
Practice address
15915 CRYSTAL CREEK DR, SUITE C, HOMER GLEN, IL 60491
(708) 529-6976
(708) 226-0010
Mailing address
15004 S. BARTLETT AVE, PLAINFIELD, IL 60544
(815) 325-3628
(708) 226-0040
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
178.006788
IL
101Y00000X
Counselor
180.010649
IL
101YP2500X
Professional Counselor
Primary
180.010649
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622805
BCBS PROVIDER NUMBER
IL
Enumeration date
08/12/2010
Last updated
08/27/2021
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