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General NPI Number Information
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NPI Number | 1003689217
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Entity Type | Organization
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Legal Business Name | MINDFUL SUPPORT PLLC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 110 N BROCKWAY ST STE 300
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City | PALATINE
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State | IL
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Zip | 60067-5063
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Country | US
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Telephone | 630-640-3539
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Fax |
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Provider Business Mailing Address
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Address Line | 38W463 CLUBHOUSE DR
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City | ST CHARLES
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State | IL
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Zip | 60175-6178
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Country | US
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Telephone | 630-640-3539
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Fax |
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | VEESSER AMINPOUR POHN
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Credential |
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Telephone | 312-536-4495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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