Provider Demographics
NPI:1518615335
Name:RESILIENT MINDS TS LLC
Entity Type:Organization
Organization Name:RESILIENT MINDS TS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-998-6935
Mailing Address - Street 1:18300 S. HALSTED ST. STE B #114
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425
Mailing Address - Country:US
Mailing Address - Phone:708-998-6935
Mailing Address - Fax:
Practice Address - Street 1:18300 S. HALSTED ST. STE B #114
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425
Practice Address - Country:US
Practice Address - Phone:708-998-6935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1508377516OtherPPO INSURANCE