Healthcare Provider Details

I. General information

NPI: 1063030872
Provider Name (Legal Business Name): MINDFUL LIFE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 W OHIO ST UNIT 2W
CHICAGO IL
60642-6276
US

IV. Provider business mailing address

1244 W OHIO ST UNIT 2W
CHICAGO IL
60642-6276
US

V. Phone/Fax

Practice location:
  • Phone: 214-693-0276
  • Fax:
Mailing address:
  • Phone: 214-693-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MASUMA RASHEED
Title or Position: OWNER
Credential: PHD
Phone: 214-693-0276