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NPI Code Detail

MEDICARE: MINDFUL BEHAVIOR LLC

MEDICARE: MINDFUL BEHAVIOR 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
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1780407189
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFUL BEHAVIOR LLC
Provider Business Mailing Address
First Line : PO BOX 388556
Second Line :
City : CHICAGO
State : IL
Zip : 60638-8556
Country : US
Telephone Number : 708-304-3010
Fax Number : 708-575-5333
Provider Business Practice Location Address
First Line : 6815 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60638-4048
Country : US
Telephone Number : 708-304-3010
Fax Number : 708-575-5333
Authorized Official
Title or Position : CEO/OWNER
Name : MRS. ELISA JULIA LEE
Credential : LCPC
Telephone Number : 708-202-9151
Provider Enumeration Date : 11/04/2024
Last Update Date : 01/23/2026

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1558065300 — MINDFUL BEHAVIOR LLC
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60638-4048
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Directions to “MINDFUL BEHAVIOR LLC ” Practice Location

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