Healthcare Provider Details

I. General information

NPI: 1548080336
Provider Name (Legal Business Name): MINDFUL PATH PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E OGDEN AVE STE 304
WESTMONT IL
60559-5554
US

IV. Provider business mailing address

1210 GILBERT AVE
DOWNERS GROVE IL
60515-4540
US

V. Phone/Fax

Practice location:
  • Phone: 630-512-1020
  • Fax:
Mailing address:
  • Phone: 630-512-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JULIE PATE
Title or Position: OWNER
Credential: LCPC
Phone: 630-512-1020