MOBILE MENTAL WELLNESS, LLC (NPI# 1497307045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497307045 |
| Entity Type | Organization |
| Organization Name | MOBILE MENTAL WELLNESS, LLC |
| Practice Address |
10208 S Indianapolis Ave Ste 301 Chicago IL 60617-6033 |
| Practice Telephone | 2192864106 |
| Mailing Telephone | 2192864106 |
| Mailing Fax Number | 8666288599 |
| Enumeration Date | 2019-07-14 |
| Last Update Date | 2019-11-03 |
| Authorized Official Name | KIMBERLY TRAVIS (OWNER) |
| Authorized Official Telephone | 2192864106 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 361685801001 | 05 | |
| IN | 300007929 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1101 Cumberland Xing # 108, Valparaiso, IN 463832356 | 8664131988 | 8666288599 |
| Street Address |
10208 S INDIANAPOLIS AVE STE 301 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60617-6033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194017269 | Kimberly Travis | Counselor | 10208 S Indianapolis Ave Ste 301, Chicago, IL 60617-6033 | 2011-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102921 | Manuel Lule | Physical Therapy Assistant | 9535 S Jeffery Boulevard, Chicago, IL 60617 | 2020-07-24 |
| 1083253546 | Vanaja Thotten | Internal Medicine | 8012 S.crandon Ave, Chicago, IL 60617 | 2020-01-02 |
| 1427527365 | Stony Island Dental PC | Dentist | 1600 E 93rd Street, Chicago, IL 60617 | 2018-11-21 |
| 1871060301 | Tamika Nicole Whitehead | Social Worker | 2822 East 83rd Street, Chicago, IL 60617 | 2018-11-02 |
| 1528543774 | Felicia Nwankwo | Nurse Practitioner | 2822 E 83rd Street Bradond Famiy Health Cener, Chicago, IL 60617 | 2018-10-03 |
| 1972099307 | David Phan | Optometrist | 1753 E 95th St Ste B-100, Chicago, IL 60617 | 2018-07-09 |
| 1831607340 | Pamela Evette Ewing | Counselor | 9145 S. Merrill Ave, Chicago, IL 60617 | 2018-01-18 |
| 1366976631 | Ali Mostafa Serhal | Radiology | 240 E. Huron St, Suite 1-203, Chicago, IL 60617 | 2017-04-13 |
| 1447784921 | 1915-25 95th St., LLC | Clinic/Center | 1915 E 95th St, Chicago, IL 60617 | 2017-04-12 |
| 1881140408 | Yeferson Laverde | Social Worker | 3062 East 31st, Chicago, IL 60617 | 2016-09-01 |
| Find all providers in zip 60617 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861024176 | Mount Sinai Community Foundation | Clinic/Center | 1414 S Fairfield, Chicago, IL 60608 | 2020-02-05 |
| 1104460922 | Infinite Care Home Physicians LLC | Clinic/Center | 6044 N Nassau Ave, Chicago, IL 60631-2649 | 2019-11-05 |
| 1962051607 | Wilkes Post Acute Care Inc | Clinic/Center | 400 W 76th St Ste 303, Chicago, IL 60620-1640 | 2019-09-05 |
| 1861964959 | Midway Medical | Clinic/Center | 2 W 103rd St, Chicago, IL 60628-2619 | 2018-12-30 |
| 1043727571 | The Board of Trustees of The University of Illinois | Clinic/Center | 835 S. Wolcott, Suite E-144; Mc 684, Chicago, IL 60612 | 2018-01-05 |
| 1386099562 | Healthworks Medical Group of Illinois S C | Clinic/Center | Gem Building 723, 1st Floor, Touhy & Mt Prospect Rd, Chicago, IL 60666 | 2016-04-26 |
| 1235584475 | Healthworks Medical Group of Illinois S C | Clinic/Center | Terminal 3, K19 Concourse, Ramp Level Rm 100, Touhy & Mt Prospect Rd, Chicago, IL 60666 | 2016-04-25 |
| 1689904039 | Prime Care Medical and Physical Therapy Centers, S.c. | Clinic/Center | 1719 W 18th St, Chicago, IL 60608-1913 | 2010-01-07 |
| 1790938249 | Healing Hands Resource Center | Clinic/Center | 3143 W Douglas Blvd, Chicago, IL 60623-1816 | 2008-10-28 |
| 1770739591 | Alivio Medical Center Inc | Clinic/Center | 3120 S Kostner Ave, Chicago, IL 60623-4842 | 2008-08-12 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.