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General NPI Number Information
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NPI Number | 1356747208
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Entity Type | Organization
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Legal Business Name | MINDSCAPES INC
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE SUITE 218
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City | CHICAGO
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State | IL
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Zip | 60625-1948
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Country | US
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Telephone | 312-841-7278
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Fax |
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Provider Business Mailing Address
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Address Line | 2334 W LAWRENCE AVE SUITE 218
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City | CHICAGO
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State | IL
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Zip | 60625-1948
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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 | MICHELLE HEYDEN
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Credential | MAAT, LCPC
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Telephone | 312-841-7278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.006189
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License Number State | IL
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