Provider Demographics
NPI:1346079159
Name:MINDFULLY MODERN THERAPY
Entity type:Organization
Organization Name:MINDFULLY MODERN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:773-270-2787
Mailing Address - Street 1:1 E WACKER DR STE 550
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-2005
Mailing Address - Country:US
Mailing Address - Phone:773-270-2787
Mailing Address - Fax:
Practice Address - Street 1:1 E WACKER DR STE 550
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-2005
Practice Address - Country:US
Practice Address - Phone:773-270-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty