Healthcare Provider Details

I. General information

NPI: 1265907539
Provider Name (Legal Business Name): HEALING PATH HEALTH PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N SHERIDAN RD STE 108
CHICAGO IL
60657-6183
US

IV. Provider business mailing address

3200 N LAKE SHORE DR APT 2505
CHICAGO IL
60657-3929
US

V. Phone/Fax

Practice location:
  • Phone: 773-331-7690
  • Fax:
Mailing address:
  • Phone: 773-331-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN MILLS
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 773-331-7690