Healthcare Provider Details

I. General information

NPI: 1144188822
Provider Name (Legal Business Name): MINDFUL MAVENS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 WATERSIDE DR
SOUTH ELGIN IL
60177-3715
US

IV. Provider business mailing address

734 WATERSIDE DR
SOUTH ELGIN IL
60177-3715
US

V. Phone/Fax

Practice location:
  • Phone: 815-994-8916
  • 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
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PRATIP NAG
Title or Position: OWNER
Credential: MD
Phone: 815-994-8916