Provider Demographics
NPI:1114641313
Name:PROSPERING MINDS COUNSELING
Entity Type:Organization
Organization Name:PROSPERING MINDS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFRAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MA
Authorized Official - Phone:815-236-5503
Mailing Address - Street 1:1403 TALL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4204
Mailing Address - Country:US
Mailing Address - Phone:815-236-5503
Mailing Address - Fax:
Practice Address - Street 1:1 E NORTHWEST HWY STE 212
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-1700
Practice Address - Country:US
Practice Address - Phone:815-236-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1114492303OtherINDIVIDUAL NPI