Provider Demographics
NPI:1295514313
Name:CHANGE OF MIND, LTD.
Entity type:Organization
Organization Name:CHANGE OF MIND, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CEPEK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:262-210-0634
Mailing Address - Street 1:1117 S MILWAUKEE AVE STE B6
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5259
Mailing Address - Country:US
Mailing Address - Phone:773-217-0440
Mailing Address - Fax:
Practice Address - Street 1:1117 S MILWAUKEE AVE STE B6
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5259
Practice Address - Country:US
Practice Address - Phone:773-217-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty