Provider Demographics
NPI:1437808433
Name:MINDPLEXITY PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:MINDPLEXITY PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRULL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:224-465-4309
Mailing Address - Street 1:1050 COUNTRY CLUB RD UNIT 386
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-5585
Mailing Address - Country:US
Mailing Address - Phone:815-404-3452
Mailing Address - Fax:224-999-4002
Practice Address - Street 1:1990 LARKIN AVE # C3
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5827
Practice Address - Country:US
Practice Address - Phone:815-404-3452
Practice Address - Fax:224-999-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty