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NPI Code Detail

MEDICARE: STATE OF MIND MENTAL HEALTH & CONSULTATION SERVICES P.C.

MEDICARE: STATE OF MIND MENTAL HEALTH & CONSULTATION SERVICES P.C.
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
1251S00000XCommunity/Behavioral Health Agency180006065IL

General Provider Information

NPI Number : 1457685604
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF MIND MENTAL HEALTH & CONSULTATION SERVICES P.C.
Provider Business Mailing Address
First Line : 17911 LOS ANGELES AVE
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-1509
Country : US
Telephone Number : 708-798-4510
Fax Number :
Provider Business Practice Location Address
First Line : 400 E 41ST ST
Second Line : SUITE 101A
City : CHICAGO
State : IL
Zip : 60653-3071
Country : US
Telephone Number : 773-285-0804
Fax Number : 773-285-0804
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. LATANYA MARIE MCFIELD
Credential :
Telephone Number : 773-807-2144
Provider Enumeration Date : 09/21/2009
Last Update Date : 09/21/2009

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Directions to “STATE OF MIND MENTAL HEALTH & CONSULTATION SERVICES P.C. ” Practice Location

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