Healthcare Provider Details

I. General information

NPI: 1376334151
Provider Name (Legal Business Name): KARLIE MIRABELLI PHD, LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W WELLINGTON AVE STE 210
CHICAGO IL
60657-7187
US

IV. Provider business mailing address

1950 N STEMMONS FWY STE 5010
DALLAS TX
75207-3199
US

V. Phone/Fax

Practice location:
  • Phone: 312-384-1940
  • Fax:
Mailing address:
  • Phone: 312-384-1940
  • Fax: 773-423-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.011446
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: