Provider Demographics
NPI:1316799729
Name:A BEAUTIFUL MIND PSYCHIATRY, PLLC.
Entity type:Organization
Organization Name:A BEAUTIFUL MIND PSYCHIATRY, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:III
Authorized Official - Credentials:NP-BC
Authorized Official - Phone:708-640-6951
Mailing Address - Street 1:6700 167TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2078
Mailing Address - Country:US
Mailing Address - Phone:708-668-4902
Mailing Address - Fax:
Practice Address - Street 1:6700 167TH ST STE 4
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2078
Practice Address - Country:US
Practice Address - Phone:708-668-4902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)