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General NPI Number Information
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NPI Number | 1326796129
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Entity Type | Organization
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Legal Business Name | MIND CARE WELLNESS CENTER
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 3833 E MAIN ST # 1039
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City | ST CHARLES
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State | IL
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Zip | 60174-2424
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Country | US
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Telephone | 773-615-6278
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Fax |
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Provider Business Mailing Address
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Address Line | 4461 WHITEHALL LN
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City | ALGONQUIN
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State | IL
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Zip | 60102-6205
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Country | US
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Telephone | 773-615-6278
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL THERAPIST
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Name | MARTA CYBULAK
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Credential | MA, LCPC
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Telephone | 773-615-6278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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