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General NPI Number Information
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NPI Number | 1902319916
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Entity Type | Organization
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Legal Business Name | MARVELOUS MINDS, INC
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 420 PENNSYLVANIA AVE STE 101
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City | GLEN ELLYN
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State | IL
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Zip | 60137-4427
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Country | US
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Telephone | 630-474-4353
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Fax | 630-790-8898
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Provider Business Mailing Address
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Address Line | 420 PENNSYLVANIA AVE STE 101
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City | GLEN ELLYN
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State | IL
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Zip | 60137-4427
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Country | US
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Telephone | 630-474-4353
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Fax | 630-790-8898
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KYMBERLY FAY LARSON
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Credential | PSYD
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Telephone | 630-474-4353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 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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