Provider Demographics
NPI:1902319916
Name:MARVELOUS MINDS, INC
Entity type:Organization
Organization Name:MARVELOUS MINDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYMBERLY
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-474-4353
Mailing Address - Street 1:420 PENNSYLVANIA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4427
Mailing Address - Country:US
Mailing Address - Phone:630-474-4353
Mailing Address - Fax:630-790-8898
Practice Address - Street 1:420 PENNSYLVANIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4427
Practice Address - Country:US
Practice Address - Phone:630-474-4353
Practice Address - Fax:630-790-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty