Healthcare Provider Details

I. General information

NPI: 1790513398
Provider Name (Legal Business Name): ALL KINDS OF MINDS THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 CHURCH ST
EVANSTON IL
60201-3875
US

IV. Provider business mailing address

1016 N OAKLEY BLVD
CHICAGO IL
60622-3560
US

V. Phone/Fax

Practice location:
  • Phone: 847-612-0149
  • Fax:
Mailing address:
  • Phone: 847-612-0149
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIA MEFFERD
Title or Position: OWNER, THERAPIST
Credential: LMFT
Phone: 847-612-0149