Organization
A BEAUTIFUL MIND CHICAGO
Active
Other names
A BEAUTIFUL MIND
Organization subpart
No
Provider details
NPI number
Authorized official
CHIQUITA LEE (CEO)
(312) 340-8826
Entity
Organization
Contact information
Practice address
5113 S HARPER AVE # 2C, CHICAGO, IL 60615-4119
(773) 304-3699
Mailing address
5113 S HARPER AVE # 2C, CHICAGO, IL 60615-4119
(773) 304-3699
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0
—
IL
Enumeration date
02/19/2021
Last updated
12/08/2021
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