Healthcare Provider Details

I. General information

NPI: 1457212268
Provider Name (Legal Business Name): INTENTIONAL HEALING PSYCHIATRIC CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 W 103RD ST STE 301D
OAK LAWN IL
60453-4868
US

IV. Provider business mailing address

9631 S CICERO AVE # 1075
OAK LAWN IL
60453-3137
US

V. Phone/Fax

Practice location:
  • Phone: 708-223-2682
  • Fax:
Mailing address:
  • Phone: 708-223-2682
  • Fax: 708-265-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIE LAND
Title or Position: MANAGER
Credential: MD
Phone: 708-223-2682