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General NPI Number Information
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NPI Number | 1144188822
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Entity Type | Organization
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Legal Business Name | MINDFUL MAVENS, LLC.
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 734 WATERSIDE DR
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-3715
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Country | US
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Telephone | 815-994-8916
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Fax |
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Provider Business Mailing Address
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Address Line | 734 WATERSIDE DR
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-3715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PRATIP NAG
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Credential | MD
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Telephone | 815-994-8916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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