Eventide Wellness Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

EVENTIDE WELLNESS INC

Practice address

7021 W 153Rd St Ste 5
Orland Park, IL 60462-5397

Phone

(708) 381-5009

Fax

(888) 419-1594

NPI assigned

Dec 1, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Michael Jenkins, LCPC

Title

Ed and Acting Secretary

Phone

(708) 275-0934

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1033714753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 764",
            "city": "MANTENO",
            "state": "IL",
            "postal_code": "609500764",
            "telephone_number": "708-275-0934",
            "fax_number": "888-419-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7021 W 153RD ST STE 5",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604625397",
            "telephone_number": "708-381-5009",
            "fax_number": "888-419-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVENTIDE WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "ED AND ACTING SECRETARY",
        "authorized_official_telephone_number": "708-275-0934",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://www.eventidewellness.org",
            "affiliation": "N",
            "address_1": "7021 W 153rd St Ste 5",
            "city": "Orland Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604625397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.