Provider Demographics
NPI:1336301969
Name:JXP HEALTHY MINDS PC
Entity Type:Organization
Organization Name:JXP HEALTHY MINDS PC
Other - Org Name:JXP HEALTHY MINDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:XIQUES-PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY,D
Authorized Official - Phone:312-492-8081
Mailing Address - Street 1:819 N ASHLAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5102
Mailing Address - Country:US
Mailing Address - Phone:312-492-8081
Mailing Address - Fax:312-492-8083
Practice Address - Street 1:819 N ASHLAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5102
Practice Address - Country:US
Practice Address - Phone:312-492-8081
Practice Address - Fax:312-492-8083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JXP HEALTHY MINDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006196251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1831260025OtherJULIE A XIQUES-PRIETO PSY,D
IL1184607608OtherMERCEDEZ MARTINEZ MD