Provider Demographics
NPI:1841657939
Name:MINDFUL WELLNESS LLC
Entity type:Organization
Organization Name:MINDFUL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:UMLAUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-730-3564
Mailing Address - Street 1:3245 GROVE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3475
Mailing Address - Country:US
Mailing Address - Phone:708-637-6981
Mailing Address - Fax:877-472-9656
Practice Address - Street 1:3245 GROVE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3474
Practice Address - Country:US
Practice Address - Phone:778-637-6981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty