Provider Demographics
NPI:1558184465
Name:MINDFUL WELLNESS COUNSELING GROUP
Entity type:Organization
Organization Name:MINDFUL WELLNESS COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEKAI
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-453-1896
Mailing Address - Street 1:900 RIDGE RD STE 1SW
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1934
Mailing Address - Country:US
Mailing Address - Phone:708-637-1672
Mailing Address - Fax:708-637-1633
Practice Address - Street 1:900 RIDGE RD STE 1SW
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1934
Practice Address - Country:US
Practice Address - Phone:708-637-1672
Practice Address - Fax:708-637-1633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDFUL WELLNESS COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty