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General NPI Number Information
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NPI Number | 1689321945
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Entity Type | Organization
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Legal Business Name | MINDVAULT HEALTH, LLC
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 5541 E LAKE DR APT E
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City | LISLE
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State | IL
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Zip | 60532-2679
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Country | US
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Telephone | 630-384-9214
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Fax |
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Provider Business Mailing Address
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Address Line | 5541 E LAKE DR APT E
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City | LISLE
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State | IL
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Zip | 60532-2679
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Country | US
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Telephone | 630-384-9214
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TODD MOKOS
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Credential |
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Telephone | 630-384-9214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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