Provider Demographics
NPI:1124892021
Name:MINDFULLY YOU THERAPY PLLC
Entity type:Organization
Organization Name:MINDFULLY YOU THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARY CATHERINE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-730-4594
Mailing Address - Street 1:33405 N LONE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1926
Mailing Address - Country:US
Mailing Address - Phone:224-730-4594
Mailing Address - Fax:
Practice Address - Street 1:10 N LAKE ST STE 109
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3636
Practice Address - Country:US
Practice Address - Phone:224-829-0878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-10
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical