Provider Demographics
NPI:1225695299
Name:MINDFUL WELLNESS COUNSELING
Entity Type:Organization
Organization Name:MINDFUL WELLNESS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEVITA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-637-1672
Mailing Address - Street 1:705 E 157TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1528
Mailing Address - Country:US
Mailing Address - Phone:708-941-4415
Mailing Address - Fax:
Practice Address - Street 1:935 175TH ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2049
Practice Address - Country:US
Practice Address - Phone:708-637-1672
Practice Address - Fax:708-637-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty