Organization
EVENTIDE WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY MICHAEL JENKINS LCPC (ED AND ACTING SECRETARY)
(708) 275-0934
Entity
Organization
Contact information
Practice address
7021 W 153RD ST STE 5, ORLAND PARK, IL 60462-5397
(708) 381-5009
(888) 419-1594
Mailing address
PO BOX 764, MANTENO, IL 60950-0764
(708) 275-0934
(888) 419-1594
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/01/2020
Last updated
12/01/2020
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