Provider Demographics
NPI:1689797276
Name:OF SOUND MIND, INC.
Entity Type:Organization
Organization Name:OF SOUND MIND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIFO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-907-8825
Mailing Address - Street 1:5215 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1668
Mailing Address - Country:US
Mailing Address - Phone:773-907-8825
Mailing Address - Fax:773-907-8841
Practice Address - Street 1:5215 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1668
Practice Address - Country:US
Practice Address - Phone:773-907-8825
Practice Address - Fax:773-907-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL276614OtherMANAGED HEALTH NETWORK
IL237540OtherCOMPSYCH CORP.
ILP-12036740OtherMULTIPLAN
IL209563Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER