Organization · NPI-2

Mini Mental Health Services, LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Grayslake, IL

NPI number1124744040
StatusActive
Last updated in NPPESOct 12, 2022

Details

NPI
1124744040
Entity type
Organization (NPI-2)
Legal business name
Mini Mental Health Services, LLC
Organization subpart
No
Enumeration date
Oct 12, 2022
Certification date
Oct 7, 2022
Last updated
Oct 12, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Practice location

531 1st St
Grayslake, IL 60030-1451

Phone 708-785-2408

Mailing address

531 1st St
Grayslake, IL 60030-1451

Phone 708-785-2408

Authorized official

Matthew L Miniscalco
Co-Founder & Partner
7087852408

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