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General NPI Number Information
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NPI Number | 1750668091
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Entity Type | Organization
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Legal Business Name | MIND BODY CO-OP
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 424
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City | CHICAGO
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State | IL
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Zip | 60602-3844
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Country | US
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Telephone | 872-274-4344
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Fax | 866-671-9991
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Provider Business Mailing Address
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Address Line | 3209 N LAKEWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60657-3215
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Country | US
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Telephone | 872-274-4344
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Fax | 866-671-9991
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Authorized Official
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Title or Position | FOUNDER OWNER
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Name | KELLIE RICE
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Credential | PSY.D., CGP
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Telephone | 872-274-4344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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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 | 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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Taxonomy #3
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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Taxonomy #5
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number |
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Taxonomy #6
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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Taxonomy #7
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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Taxonomy #8
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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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Taxonomy #9
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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Taxonomy #10
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #11
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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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