Provider Demographics
NPI:1275121212
Name:MINDFUL INTENTIONS,LLC
Entity Type:Organization
Organization Name:MINDFUL INTENTIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALISI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:224-733-6165
Mailing Address - Street 1:26W342 MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2264
Mailing Address - Country:US
Mailing Address - Phone:847-410-9018
Mailing Address - Fax:
Practice Address - Street 1:26W342 MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2264
Practice Address - Country:US
Practice Address - Phone:847-410-9018
Practice Address - Fax:941-200-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty