Provider Demographics
NPI:1386382505
Name:COVERT MINDS THERAPY
Entity type:Organization
Organization Name:COVERT MINDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:BOLOTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-924-0775
Mailing Address - Street 1:239 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3101
Mailing Address - Country:US
Mailing Address - Phone:847-924-0775
Mailing Address - Fax:
Practice Address - Street 1:111 W WASHINGTON ST STE 1042
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2741
Practice Address - Country:US
Practice Address - Phone:872-222-9388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty