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General NPI Number Information
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NPI Number | 1649001314
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Entity Type | Organization
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Legal Business Name | MIND BODY BEHAVIORAL HEALTH, PLCC
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR STE 1101768
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 847-680-9924
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Fax | 847-680-9924
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Provider Business Mailing Address
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Address Line | 1S150 SPRING RD APT 3I
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-4612
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Country | US
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Telephone | 708-606-1147
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MS. DAYNA LONG
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Credential | PMHNP, FNP
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Telephone | 708-606-1147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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