Provider Demographics
NPI:1639506504
Name:HEART & MIND, LLC
Entity Type:Organization
Organization Name:HEART & MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:MALLONI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:413-204-1985
Mailing Address - Street 1:3003 N ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6911
Mailing Address - Country:US
Mailing Address - Phone:413-204-1985
Mailing Address - Fax:
Practice Address - Street 1:3147 W LOGAN BLVD
Practice Address - Street 2:SUITE 5W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1613
Practice Address - Country:US
Practice Address - Phone:413-204-1985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty