Healthcare Provider Details

I. General information

NPI: 1144154576
Provider Name (Legal Business Name): MIRAKINS BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14855 S VAN DYKE RD UNIT 822
PLAINFIELD IL
60544-9998
US

IV. Provider business mailing address

14855 S VAN DYKE RD UNIT 822
PLAINFIELD IL
60544-9998
US

V. Phone/Fax

Practice location:
  • Phone: 331-330-7509
  • Fax:
Mailing address:
  • Phone: 331-330-7509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAOBI MIRIAN INNOCENT
Title or Position: OWNER
Credential: DNP, PMHNP-BC
Phone: 262-330-3272