Provider Demographics
NPI:1689319451
Name:JON POINDEXTER'S SPIRIT, MIND, BODY ( SMB THERAPY ) CORPORATION
Entity Type:Organization
Organization Name:JON POINDEXTER'S SPIRIT, MIND, BODY ( SMB THERAPY ) CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION LEADER/ FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:POINDEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-622-6995
Mailing Address - Street 1:118 N CLINTON ST STE 440
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2392
Mailing Address - Country:US
Mailing Address - Phone:312-622-6995
Mailing Address - Fax:
Practice Address - Street 1:118 N CLINTON ST STE 440
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2392
Practice Address - Country:US
Practice Address - Phone:312-622-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty