Provider Demographics
NPI:1609470137
Name:CENTER FOR MIND HEALTH
Entity Type:Organization
Organization Name:CENTER FOR MIND HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:JAKOBSONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-210-0528
Mailing Address - Street 1:3559 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1819
Mailing Address - Country:US
Mailing Address - Phone:216-210-0528
Mailing Address - Fax:
Practice Address - Street 1:1020 MILWAUKEE AVE STE 320
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3561
Practice Address - Country:US
Practice Address - Phone:216-210-0528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty