Healthcare Provider Details

I. General information

NPI: 1427970441
Provider Name (Legal Business Name): MIRRORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W JEFFERSON ST
SPRINGFIELD IL
62702-4833
US

IV. Provider business mailing address

901 W JEFFERSON ST # PO423
SPRINGFIELD IL
62702-4833
US

V. Phone/Fax

Practice location:
  • Phone: 217-801-8639
  • Fax:
Mailing address:
  • Phone: 217-801-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DESHUN R MIMS
Title or Position: CEO
Credential: ETC.
Phone: 217-801-8639