Provider Demographics
NPI:1740726330
Name:A CLEARER MIND LLC
Entity type:Organization
Organization Name:A CLEARER MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-945-5074
Mailing Address - Street 1:110 E SCHILLER ST STE 252
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2858
Mailing Address - Country:US
Mailing Address - Phone:858-945-5074
Mailing Address - Fax:
Practice Address - Street 1:110 E SCHILLER ST STE 252
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2858
Practice Address - Country:US
Practice Address - Phone:858-945-5074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.015920251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health