Provider Demographics
NPI:1255032579
Name:MEDICAL MIND CLARITY INC
Entity type:Organization
Organization Name:MEDICAL MIND CLARITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE- OSAGHAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-616-4338
Mailing Address - Street 1:17359 S MCKENNA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-9292
Mailing Address - Country:US
Mailing Address - Phone:708-741-2325
Mailing Address - Fax:888-207-0577
Practice Address - Street 1:1333 S SCHOOLHOUSE RD STE 109
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2746
Practice Address - Country:US
Practice Address - Phone:708-741-2325
Practice Address - Fax:888-207-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty