Provider Demographics
NPI:1811412166
Name:CROSSWINDS CENTER FOR PERSONAL AND PROFESSIONAL DEVELOPMENT, PLLC
Entity Type:Organization
Organization Name:CROSSWINDS CENTER FOR PERSONAL AND PROFESSIONAL DEVELOPMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL, LICENSED CLINICAL PSYCH
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-849-8275
Mailing Address - Street 1:3125 N WILKE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1452
Mailing Address - Country:US
Mailing Address - Phone:833-710-7770
Mailing Address - Fax:224-345-2118
Practice Address - Street 1:3125 N WILKE RD STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1452
Practice Address - Country:US
Practice Address - Phone:833-710-7770
Practice Address - Fax:224-345-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty