Provider Demographics
NPI:1558035519
Name:MINDFUL BEHAVIOR
Entity Type:Organization
Organization Name:MINDFUL BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-304-3010
Mailing Address - Street 1:PO BOX 388556
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8556
Mailing Address - Country:US
Mailing Address - Phone:708-304-3010
Mailing Address - Fax:708-575-5333
Practice Address - Street 1:6815 W 63RD ST STE 7
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4066
Practice Address - Country:US
Practice Address - Phone:708-304-3010
Practice Address - Fax:708-575-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty