Provider Demographics
NPI:1477805463
Name:THE MINDFUL SELF, LLC
Entity type:Organization
Organization Name:THE MINDFUL SELF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HILEWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LLP, LPC
Authorized Official - Phone:248-543-0033
Mailing Address - Street 1:31201 CHICAGO RD S STE A201
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5552
Mailing Address - Country:US
Mailing Address - Phone:248-543-0033
Mailing Address - Fax:248-548-5309
Practice Address - Street 1:31201 CHICAGO RD S STE A201
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5552
Practice Address - Country:US
Practice Address - Phone:248-543-0033
Practice Address - Fax:248-548-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301024395103T00000X
MI6401011013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty