The Modern Wellness Collective, PLLC
Clinic/Center, Adult Mental Health in Chicago, IL. Organization (NPI-2).
NPI number1164200093
StatusActive
Last updated in NPPESNov 1, 2024
Details
- NPI
- 1164200093
- Entity type
- Organization (NPI-2)
- Legal business name
- The Modern Wellness Collective, PLLC
- Organization subpart
- No
- Enumeration date
- Sep 20, 2023
- Certification date
- Nov 1, 2024
- Last updated
- Nov 1, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | Yes |
Practice location
661 W Lake St Ste 2sChicago, IL 60661-1034
Phone 419-681-5889
Mailing address
661 W Lake St Ste 2sChicago, IL 60661-1034
Authorized official
Kirsten Hall-Baldwin
Licensed Therapist
4196815889
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