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General NPI Number Information
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NPI Number | 1801339254
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Entity Type | Organization
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Legal Business Name | MINDSET HEALTH PC
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 2617 W COYLE AVE
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City | CHICAGO
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State | IL
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Zip | 60645-3214
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Country | US
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Telephone | 773-407-8626
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Fax |
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Provider Business Mailing Address
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Address Line | 53 W JACKSON BLVD SUITE 1022
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City | CHICAGO
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State | IL
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Zip | 60604-3606
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Country | US
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Telephone | 773-407-8626
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. JASON HERR
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Credential | PSY.D.
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Telephone | 773-407-8626
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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 | 071.008452
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License Number State | IL
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