| Mindful Support Pllc | |
|
110 N Brockway St Ste 300 Palatine IL 60067-5063 | |
| (630) 640-3539 | |
| Not Available |
| Full Name | Mindful Support Pllc |
|---|---|
| Speciality | Counselor |
| Location | 110 N Brockway St Ste 300, Palatine, Illinois |
| Authorized Official Name and Position | Tracy Lanier (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3125364495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Support Pllc 38w463 Clubhouse Dr St Charles IL 60175-6178 Ph: (630) 640-3539 | Mindful Support Pllc 110 N Brockway St Ste 300 Palatine IL 60067-5063 Ph: (630) 640-3539 |
| NPI Number | 1003689217 |
|---|---|
| Provider Enumeration Date | 10/31/2023 |
| Last Update Date | 10/31/2023 |
| Certification Date | 10/31/2023 |
| Medicare PECOS PAC ID | 3870936842 |
|---|---|
| Medicare Enrollment ID | O20240206004209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003689217 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Tracy A Lanier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417228560 PECOS PAC ID: 7315368958 Enrollment ID: I20200605001958 |
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