MEDICARE: MINDFUL EVOLUTION COUNSELING, PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1578338984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL EVOLUTION COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	955 BUFFALO CREEK DR
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2757
Country	:	US
Telephone Number	:	847-530-0828
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 BUFFALO CREEK DR
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2757
Country	:	US
Telephone Number	:	847-530-0828
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KATHLEEN FRIDDLE
Credential	:	MS, LCPC
Telephone Number	:	847-530-0828

Provider Enumeration Date	:	11/16/2023
Last Update Date	:	11/16/2023

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