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NPI Code Detail

MEDICARE: MIND BODY CO-OP

MEDICARE: MIND BODY CO-OP
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
1103TA0400XAddiction (Substance Use Disorder) Psychologist
2101YM0800XMental Health Counselor
3133VN1201XObesity and Weight Management Nutrition Registered Dietitian
4103G00000XClinical Neuropsychologist
5103TH0004XHealth Psychologist
6103TP2701XGroup Psychotherapy Psychologist
72083A0300XAddiction Medicine (Preventive Medicine) Physician
81041C0700XClinical Social Worker
9101YP2500XProfessional CounselorIL
10106H00000XMarriage & Family Therapist
11363LP0808XPsychiatric/Mental Health Nurse Practitioner

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11750668091OTHERILMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750668091
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIND BODY CO-OP
Provider Business Mailing Address
First Line : 3209 N LAKEWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3215
Country : US
Telephone Number : 872-274-4344
Fax Number : 866-671-9991
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 424
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3844
Country : US
Telephone Number : 872-274-4344
Fax Number : 866-671-9991
Authorized Official
Title or Position : FOUNDER OWNER
Name : KELLIE RICE
Credential : PSY.D., CGP
Telephone Number : 872-274-4344
Provider Enumeration Date : 11/15/2011
Last Update Date : 12/11/2025

Similar Medicare Providers

1891002242 — MS. KELLIE RICE PSY. D., LCPC, CGP
Practice Location Address:
30 N MICHIGAN AVE STE 424
CHICAGO, IL
60602-3844
Practice Phone: 312-279-9981
Practice Fax: 312-279-9981
1346111622 — QIUCHEN SHEN
Practice Location Address:
30 N MICHIGAN AVE STE 424
CHICAGO, IL
60602-3844
Practice Phone: 872-274-4344
Practice Fax: 866-671-9991
1184256232 — BETHANY BACON LCSW
Practice Location Address:
30 N MICHIGAN AVE STE 424
CHICAGO, IL
60602-3844
Practice Phone: 312-279-9981
Practice Fax:
1083921076 — DR. BETH MARIE ELIA PSYD
Practice Location Address:
30 N MICHIGAN AVE STE 424
CHICAGO, IL
60602-3844
Practice Phone: 312-279-9981
Practice Fax: 312-332-4281
1770174559 — KELLIE RINEHART RICE LCPC, LTD
Practice Location Address:
30 N MICHIGAN AVE STE 424
CHICAGO, IL
60602-3844
Practice Phone: 312-279-9981
Practice Fax: 312-279-9981
1053703603 — ANNE CARTER LCSW, CADC
Practice Location Address:
30 N MICHIGAN AVE STE 424
CHICAGO, IL
60602-3844
Practice Phone: 312-279-9981
Practice Fax: 312-279-9981

Directions to “MIND BODY CO-OP ” Practice Location

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