Provider Demographics
NPI:1750149308
Name:MIND DESIGN THERAPIES PLLC
Entity type:Organization
Organization Name:MIND DESIGN THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLIN PROF COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CADC
Authorized Official - Phone:847-809-5311
Mailing Address - Street 1:203 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3405
Mailing Address - Country:US
Mailing Address - Phone:847-809-5311
Mailing Address - Fax:
Practice Address - Street 1:203 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3405
Practice Address - Country:US
Practice Address - Phone:847-809-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health