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General NPI Number Information
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NPI Number | 1144091067
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Entity Type | Organization
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Legal Business Name | MIND CARE TELEPSYCHIATRY
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 21141 GOVERNORS HWY STE 114
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City | MATTESON
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State | IL
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Zip | 60443-3818
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Country | US
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Telephone | 708-759-8975
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Fax |
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Provider Business Mailing Address
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Address Line | 21141 GOVERNORS HWY STE 114
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City | MATTESON
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State | IL
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Zip | 60443-3818
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Country | US
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Telephone | 708-759-8975
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VENESSANN THORNTON-MCLENDON
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Credential |
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Telephone | 708-759-8975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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