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General NPI Number Information
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NPI Number | 1144909151
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Entity Type | Organization
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Legal Business Name | PRIME MIND HEALTH SERVICES LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 230 E OHIO ST STE 410
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City | CHICAGO
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State | IL
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Zip | 60611-5288
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Country | US
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Telephone | 312-678-4449
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Fax |
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Provider Business Mailing Address
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Address Line | 230 E OHIO ST STE 410
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City | CHICAGO
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State | IL
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Zip | 60611-5288
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Country | US
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Telephone | 312-678-4449
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COMFORT LACY
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Credential | NP
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Telephone | 312-678-4449
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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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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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