Provider Demographics
NPI:1649518515
Name:MIND BODY CONNECTIONS PLLC
Entity type:Organization
Organization Name:MIND BODY CONNECTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-543-2133
Mailing Address - Street 1:3S101 ROCKWELL ST UNIT 247
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2948
Mailing Address - Country:US
Mailing Address - Phone:312-543-2133
Mailing Address - Fax:
Practice Address - Street 1:24W788 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1684
Practice Address - Country:US
Practice Address - Phone:312-543-2133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2023-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X, 101YP2500X, 225600000X
IL180-003221261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty