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General NPI Number Information
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NPI Number | 1639506504
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Entity Type | Organization
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Legal Business Name | HEART & MIND, LLC
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 3147 W LOGAN BLVD SUITE 5W
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City | CHICAGO
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State | IL
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Zip | 60647-1613
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Country | US
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Telephone | 413-204-1985
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 N ALBANY AVE
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City | CHICAGO
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State | IL
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Zip | 60618-6911
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Country | US
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Telephone | 413-204-1985
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. AMANDA CHRISTINE MALLONI
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Credential | LCPC
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Telephone | 413-204-1985
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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 | 180008704
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License Number State | IL
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