Provider Demographics
NPI:1598381188
Name:HEALTHY MIND & LIFE COUNSELING CENTER
Entity Type:Organization
Organization Name:HEALTHY MIND & LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-455-5173
Mailing Address - Street 1:3047 W CERMAK RD FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3421
Mailing Address - Country:US
Mailing Address - Phone:312-318-1022
Mailing Address - Fax:
Practice Address - Street 1:3047 W CERMAK RD FL 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3421
Practice Address - Country:US
Practice Address - Phone:312-318-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty