Mindfully Well PLLC

Primary specialty

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

Legal business name

MINDFULLY WELL PLLC

Practice address

2463 Highmoor Rd
Highland Park, IL 60035-1705

Phone

(847) 450-6974

NPI assigned

Jun 1, 2023

Last updated

Jun 1, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alice Shierk-Booth, LCPCNPI 1295389948

Title

Owner

Phone

(312) 505-9942

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alice Shierk-Booth, LCPC

  • Professional Counselor
  • Highland Park, IL
  • NPI 1295389948
  NPD Authorized official

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685577600000",
    "number": "1538852702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2463 HIGHMOOR RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600351705",
            "telephone_number": "847-450-6974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2463 HIGHMOOR RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600351705",
            "telephone_number": "847-450-6974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFULLY WELL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "SHIERK-BOOTH",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-505-9942",
        "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": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Highland Park, IL
• Providers in Highland 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 Jun 1, 2023; 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.