MEDICARE: RENEWED MINDS THERAPY & WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1013868371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED MINDS THERAPY & WELLNESS LLC

Provider Business Mailing Address
First Line	:	7000 W FOREST PRESERVE DR STE 1116
Second Line	:
City	:	NORRIDGE
State	:	IL
Zip	:	60706-7123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2623 N MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639
Country	:	US
Telephone Number	:	773-307-5226
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LYNN MARIE WEISHAUPT
Credential	:	PSYD
Telephone Number	:	773-307-5226

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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