Provider Demographics
NPI:1720803455
Name:MIND OVER MATTER PSYCHOTHERAPY P.C.
Entity type:Organization
Organization Name:MIND OVER MATTER PSYCHOTHERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/ LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAKAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULCAHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-620-7742
Mailing Address - Street 1:1802 N DIVISION ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1184
Mailing Address - Country:US
Mailing Address - Phone:708-620-7742
Mailing Address - Fax:
Practice Address - Street 1:1802 N DIVISION ST STE 300
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1184
Practice Address - Country:US
Practice Address - Phone:708-620-7742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty