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General NPI Number Information
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NPI Number | 1811633118
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Entity Type | Organization
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Legal Business Name | MINDFUL PATH THERAPY PLLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 1803 E WISTORIA CT
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-1829
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Country | US
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Telephone | 224-423-9396
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 E WISTORIA CT
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-1829
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Country | US
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Telephone | 224-423-9396
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JUDITH LUCAS
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Credential | LCPC, CADC
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Telephone | 224-423-9396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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