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General NPI Number Information
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NPI Number | 1417750878
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Entity Type | Organization
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Legal Business Name | MINDFUL MOMENTS
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 16649 OAK PARK AVE STE H
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City | TINLEY PARK
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State | IL
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Zip | 60477-1843
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Country | US
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Telephone | 312-768-8090
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Fax |
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Provider Business Mailing Address
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Address Line | 16649 OAK PARK AVE STE H
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City | TINLEY PARK
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State | IL
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Zip | 60477-1843
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Country | US
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Telephone | 312-768-8090
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | TENILYA MUMPHUS
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Credential | LCSW
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Telephone | 312-931-5157
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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