Healthcare Provider Details

I. General information

NPI: 1750149308
Provider Name (Legal Business Name): MIND DESIGN THERAPIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BEVERLY RD
BARRINGTON IL
60010-3405
US

IV. Provider business mailing address

203 BEVERLY RD
BARRINGTON IL
60010-3405
US

V. Phone/Fax

Practice location:
  • Phone: 847-809-5311
  • Fax:
Mailing address:
  • Phone: 847-809-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY J HENRY
Title or Position: LICENSED CLIN PROF COUNSELOR
Credential: LCPC, CADC
Phone: 847-809-5311