MEDICARE: CENTER FOR THE HEALING MIND 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1942771548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR THE HEALING MIND PLLC

Provider Business Mailing Address
First Line	:	208 RENROSE AVE
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4046
Country	:	US
Telephone Number	:	815-742-7516
Fax Number	:

Provider Business Practice Location Address
First Line	:	6653 WEAVER RD STE 105
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8052
Country	:	US
Telephone Number	:	815-988-2524
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARIN K LEDEN
Credential	:
Telephone Number	:	815-742-7516

Provider Enumeration Date	:	12/09/2018
Last Update Date	:	01/23/2019

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Directions to “CENTER FOR THE HEALING MIND PLLC ” Practice Location

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