Provider Demographics
NPI:1215134721
Name:SOUND MIND, SOUND BODY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:SOUND MIND, SOUND BODY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MCFAIL
Authorized Official - Last Name:WEINGARZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-356-5499
Mailing Address - Street 1:2200 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4419
Mailing Address - Country:US
Mailing Address - Phone:815-356-5499
Mailing Address - Fax:815-356-7139
Practice Address - Street 1:2200 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4419
Practice Address - Country:US
Practice Address - Phone:815-356-5499
Practice Address - Fax:815-356-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295717858OtherINDIVIDUAL NPI #
IL05632128OtherBCBS PPO PROVIDER #
1295717858OtherINDIVIDUAL NPI #
ILK13927Medicare ID - Type UnspecifiedMEDICARE PROVIDER #