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General NPI Number Information
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NPI Number | 1457793127
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Entity Type | Organization
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Legal Business Name | CENTER FOR MINDFULNESS AND PSYCHOTHERAPY INC
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 3624 216TH ST
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City | MATTESON
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State | IL
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Zip | 60443-2713
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Country | US
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Telephone | 708-220-2696
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Fax | 708-481-7725
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Provider Business Mailing Address
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Address Line | 3624 216TH ST
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City | MATTESON
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State | IL
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Zip | 60443-2713
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Country | US
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Telephone | 708-220-2696
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Fax | 708-481-7725
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY W. PEDIGO
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Credential | PH.D.
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Telephone | 708-220-2696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0713996
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License Number State | IL
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