Organization · NPI-2

A Beautiful Mind, INC

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

NPI number1851959357
StatusActive
Last updated in NPPESDec 8, 2021

Details

NPI
1851959357
Entity type
Organization (NPI-2)
Legal business name
A Beautiful Mind, INC
Organization subpart
No
Enumeration date
May 31, 2019
Certification date
Dec 8, 2021
Last updated
Dec 8, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes
261QM0850X Clinic/Center, Adult Mental Health––
261QM0855X Clinic/Center, Adolescent and Children Mental Health––

Practice location

5113 S Harper Ave # 2c
Chicago, IL 60615-4119

Phone 773-304-3699

Mailing address

5113 S Harper Ave # 2c
Chicago, IL 60615-4119

Phone 773-304-3699 · Fax 773-304-4555

Authorized official

Chiquita Lee
Ceo
7733043699

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