NPIMap

Organization Active NPI

The Mindful Self, LLC

  • Professional Counselor
  • Warren, MI
National Provider Identifier
1477805463
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401011013 Issued in MI
Legal business name
THE MINDFUL SELF, LLC
Practice address
31201 Chicago Rd S Ste A201
Warren, MI 48093-5552
Phone
(248) 543-0033
Fax
(248) 548-5309
NPI assigned
Oct 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Authorized official

Name
Dr. Alisa M Hilewsky, PSYD, LLP, LPCNPI 1407002447
Title
Clinical Psychologist
Phone
(248) 543-0033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 6401011013 MI Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 6301024395 MI

Addresses

Primary practice location

31201 Chicago Rd S Ste A201
Warren, MI 48093-5552

Mailing address

31201 Chicago Rd S Ste A201
Warren, MI 48093-5552
Phone (248) 543-0033

Other practice location 1

64541 Van Dyke Rd Ste 101B
Washington Twp, MI 48095-2570
Phone (248) 543-0033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140609000185 MI Part B Supplier - Clinic/Group Practice 1456575711 Receives reassigned benefits from 11 practitioners
Practice locations: Warren, MI; Washington Township, MI

National Provider Directory

National Provider Directory

Locations

28303 Dequindre Rd
Ste 200
Madison Heights, MI 48071
Phone (248) 543-0033

31201 Chicago Rd S
Ste A201
Warren, MI 48093
Phone (248) 543-0033

64541 Van Dyke Rd
Ste 100
Washington Township, MI 48095
Phone (248) 543-0033

64541 Van Dyke Rd
Ste 101B
Washington Twp, MI 48095
Phone (248) 543-0033

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1477805463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31201 CHICAGO RD S STE A201",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480935552",
            "telephone_number": "248-543-0033",
            "fax_number": "248-548-5309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31201 CHICAGO RD S STE A201",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480935552",
            "telephone_number": "248-543-0033",
            "fax_number": "248-548-5309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "64541 Van Dyke Rd Ste 101B",
            "address_purpose": "LOCATION",
            "city": "Washington Twp",
            "state": "MI",
            "postal_code": "480952570",
            "country_code": "US",
            "telephone_number": "248-543-0033",
            "fax_number": "248-548-5309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE MINDFUL SELF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A",
        "authorized_official_last_name": "HILEWSKY",
        "authorized_official_first_name": "ALISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "248-543-0033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LLP, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401011013",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301024395",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.