Provider Demographics
NPI: | 1922661545 |
---|---|
Name: | INSIGHTFUL MINDS COUNSELING |
Entity Type: | Organization |
Organization Name: | INSIGHTFUL MINDS COUNSELING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL SOCIAL WORKER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PATRICK |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FRAME |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSW, LCSW |
Authorized Official - Phone: | 314-669-1249 |
Mailing Address - Street 1: | 2220 S STATE ROUTE 157 STE 200F |
Mailing Address - Street 2: | |
Mailing Address - City: | GLEN CARBON |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 62034-1724 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2220 S STATE ROUTE 157 STE 200F |
Practice Address - Street 2: | |
Practice Address - City: | GLEN CARBON |
Practice Address - State: | IL |
Practice Address - Zip Code: | 62034-1724 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-669-1249 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-04-18 |
Last Update Date: | 2021-06-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 1043784382 | Other | NPI TYPE 1 |