Provider Demographics
NPI:1336654029
Name:MINDFUL THERAPY, INC.
Entity Type:Organization
Organization Name:MINDFUL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIELAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-945-6728
Mailing Address - Street 1:1122 W CATALPA AVE APT 602
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7083
Mailing Address - Country:US
Mailing Address - Phone:312-945-6728
Mailing Address - Fax:
Practice Address - Street 1:1122 W CATALPA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1472
Practice Address - Country:US
Practice Address - Phone:312-945-6728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty