Provider Demographics
NPI:1942771548
Name:CENTER FOR THE HEALING MIND PLLC
Entity Type:Organization
Organization Name:CENTER FOR THE HEALING MIND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-742-7516
Mailing Address - Street 1:208 RENROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4046
Mailing Address - Country:US
Mailing Address - Phone:815-742-7516
Mailing Address - Fax:
Practice Address - Street 1:6653 WEAVER RD STE 105
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8052
Practice Address - Country:US
Practice Address - Phone:815-988-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-09
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)