Provider Demographics
NPI:1801409974
Name:MINDFUL PSYCHIATRIC SERVICES, MDSC
Entity Type:Organization
Organization Name:MINDFUL PSYCHIATRIC SERVICES, MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-941-3882
Mailing Address - Street 1:1802 N DIVISION ST STE 509
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3107
Mailing Address - Country:US
Mailing Address - Phone:815-941-3882
Mailing Address - Fax:815-941-3884
Practice Address - Street 1:1802 N DIVISION ST STE 509
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3107
Practice Address - Country:US
Practice Address - Phone:815-941-3882
Practice Address - Fax:815-941-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty