Provider Demographics
NPI:1598032922
Name:DR. DEBRA M. BLOCK AND ASSOCIATES, MINDFUL SOLUTIONS LLC
Entity Type:Organization
Organization Name:DR. DEBRA M. BLOCK AND ASSOCIATES, MINDFUL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-409-0050
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1275 SHERMER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4558
Practice Address - Country:US
Practice Address - Phone:847-409-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006426251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health