Provider Demographics
NPI:1407170194
Name:RADIANT MIND COUNSELING CENTER INC
Entity Type:Organization
Organization Name:RADIANT MIND COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:UMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVAE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-410-2029
Mailing Address - Street 1:8170 MCCORMICK BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-410-2029
Mailing Address - Fax:847-410-2041
Practice Address - Street 1:8170 MCCORMICK BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2961
Practice Address - Country:US
Practice Address - Phone:847-410-2029
Practice Address - Fax:847-410-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361205082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty