Provider Demographics
NPI:1821704115
Name:BE MINDFUL CHICAGO COUNSELING, LLC
Entity Type:Organization
Organization Name:BE MINDFUL CHICAGO COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYCHOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-234-4042
Mailing Address - Street 1:457 W DEMING PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1718
Mailing Address - Country:US
Mailing Address - Phone:415-310-1235
Mailing Address - Fax:
Practice Address - Street 1:1820 W WEBSTER AVE STE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4892
Practice Address - Country:US
Practice Address - Phone:773-234-4042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205595907OtherNPI
IL1013644707OtherNPI