Healthcare Provider Details

I. General information

NPI: 1932948619
Provider Name (Legal Business Name): MYNDFL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SKOKIE BLVD STE 101
NORTHBROOK IL
60062-1621
US

IV. Provider business mailing address

324 LINCOLN AVE
GLENCOE IL
60022-1558
US

V. Phone/Fax

Practice location:
  • Phone: 708-232-6580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHARI KALIK-MILLER
Title or Position: PRESIDENT
Credential:
Phone: 708-232-6580