Healthcare Provider Details

I. General information

NPI: 1790601326
Provider Name (Legal Business Name): MIND TO MIND PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W ROSCOE ST
CHICAGO IL
60657-8988
US

IV. Provider business mailing address

2835 N SHEFFIELD AVE STE 408
CHICAGO IL
60657-5084
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-4877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NIR EILON
Title or Position: LICENSED CLINICAL PROFESSIONAL COUN
Credential:
Phone: 312-961-7225