Provider Demographics
NPI:1639651235
Name:CENTER FOR MIND-BODY HEALTH, INC.
Entity Type:Organization
Organization Name:CENTER FOR MIND-BODY HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNAFER
Authorized Official - Middle Name:ANN BRUCHAUSER
Authorized Official - Last Name:SARNA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-401-9355
Mailing Address - Street 1:20855 S LA GRANGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1342
Mailing Address - Country:US
Mailing Address - Phone:815-401-9355
Mailing Address - Fax:815-422-3055
Practice Address - Street 1:20855 S LA GRANGE RD STE 100
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1342
Practice Address - Country:US
Practice Address - Phone:815-401-9355
Practice Address - Fax:815-422-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009501261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)