Provider Demographics
NPI:1699548198
Name:MINDSPRING EMDR, PLLC
Entity type:Organization
Organization Name:MINDSPRING EMDR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:847-780-6575
Mailing Address - Street 1:11 N NORTHWEST HWY STE 126
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3444
Mailing Address - Country:US
Mailing Address - Phone:847-780-6575
Mailing Address - Fax:
Practice Address - Street 1:11 N NORTHWEST HWY STE 126
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3444
Practice Address - Country:US
Practice Address - Phone:847-780-6575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty