Provider Demographics
NPI:1578377248
Name:MAHADEVIA, MISHA (LPC)
Entity type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:MAHADEVIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N LAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2826
Mailing Address - Country:US
Mailing Address - Phone:630-404-1348
Mailing Address - Fax:
Practice Address - Street 1:630 TOLLGATE RD STE B
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9302
Practice Address - Country:US
Practice Address - Phone:312-927-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional