Provider Demographics
NPI:1669292595
Name:MINDFUL BROTHERS COLLECTIVE FOUNDATION
Entity type:Organization
Organization Name:MINDFUL BROTHERS COLLECTIVE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-742-6684
Mailing Address - Street 1:4250 N MARINE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1936
Mailing Address - Country:US
Mailing Address - Phone:773-742-6684
Mailing Address - Fax:
Practice Address - Street 1:4250 N MARINE DR STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1936
Practice Address - Country:US
Practice Address - Phone:773-742-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical