Chicago Mental and Lifewellness Institute

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

CHICAGO MENTAL AND LIFEWELLNESS INSTITUTE

Practice address

4645 S King Dr
Chicago, IL 60653-4148

Phone

(773) 439-9748

NPI assigned

Jan 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jimalita Tillman

Title

Manager

Phone

(773) 439-9748

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1013507433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 S KING DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606534148",
            "telephone_number": "773-439-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 S KING DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606534148",
            "telephone_number": "773-439-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO MENTAL AND LIFEWELLNESS INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "JIMALITA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-439-9748"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chicago Mobile Foot Care Limited
• Chicago Modern Therapy PLLC

• Adolescent and Children Mental Health Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Adolescent and Children Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.