Mandala Counseling & Psychological Services, PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MANDALA COUNSELING & PSYCHOLOGICAL SERVICES, PLLC

Practice address

5212 N. Clark Street
Suite 222
Chicago, IL 60640-1223

Phone

(773) 454-7202

Fax

(773) 465-5041

NPI assigned

May 7, 2019

Organization subpart

No

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

Authorized official

Name

Kenneth Jackson, PH.D.

Title

Owner

Phone

(773) 454-7202

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Moises Ventura, LCPC

  • Counselor
  • Chicago, IL
  • NPI 1730933292
  NPD

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557187200000",
    "number": "1538724364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5212 N. CLARK STREET",
            "address_2": "SUITE 222",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401223",
            "telephone_number": "773-454-7202",
            "fax_number": "773-465-5041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5212 N. CLARK STREET",
            "address_2": "SUITE 222",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401223",
            "telephone_number": "773-454-7202",
            "fax_number": "773-465-5041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDALA COUNSELING & PSYCHOLOGICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-05-07",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-454-7202",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Danielle Loverde Manczko
• Sarah Frances Manczko, PA-C
• Sahita Indira Manda
• Alexander Lazar Mandadjiev
• Ronnie Ranjan Mandal, D.O,MBA,MS,MT(ASCP)
• Mandala Restorative Therapy
• Tessa Marie Mandala, M.ED., LCPC
• Margaret Mandato
• Mandel Dermatology Chicago PLLC
• Andrea Elizabeth Mandel

• Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; 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.