Provider Demographics
NPI:1417750878
Name:MINDFUL MOMENTS
Entity type:Organization
Organization Name:MINDFUL MOMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TENILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMPHUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-931-5157
Mailing Address - Street 1:1669 OAK PARK AVE
Mailing Address - Street 2:STE H #2034
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1417
Mailing Address - Country:US
Mailing Address - Phone:312-768-8090
Mailing Address - Fax:
Practice Address - Street 1:1669 OAK PARK AVE
Practice Address - Street 2:STE H #2034
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1417
Practice Address - Country:US
Practice Address - Phone:312-768-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)