Healthcare Provider Details

I. General information

NPI: 1578796934
Provider Name (Legal Business Name): MIND AT EASE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W SUPERIOR ST UNIT 803
CHICAGO IL
60654-7654
US

IV. Provider business mailing address

101 W SUPERIOR ST UNIT 803
CHICAGO IL
60654-7654
US

V. Phone/Fax

Practice location:
  • Phone: 630-874-2542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007217
License Number StateIL

VIII. Authorized Official

Name: MS. NIRALI D DALIA
Title or Position: PRESIDENT
Credential: LCPC
Phone: 630-874-2542