Healthcare Provider Details

I. General information

NPI: 1417750878
Provider Name (Legal Business Name): MINDFUL MOMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16649 OAK PARK AVE STE H
TINLEY PARK IL
60477-1843
US

IV. Provider business mailing address

16649 OAK PARK AVE STE H
TINLEY PARK IL
60477-1843
US

V. Phone/Fax

Practice location:
  • Phone: 312-768-8090
  • Fax:
Mailing address:
  • Phone: 312-768-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TENILYA MUMPHUS
Title or Position: OWNER/CEO
Credential: LCSW
Phone: 312-931-5157