Mind Well Psychological Services, LLC.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.007814 Issued in IL

Legal business name

MIND WELL PSYCHOLOGICAL SERVICES, LLC.

Practice address

9290 Forest Edge Dr
Burr Ridge, IL 60527-6680

Phone

(708) 466-6443

NPI assigned

Jul 11, 2010

Last updated

Aug 7, 2013By 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

Dr. Lori Q. Chaib, PSY.D.NPI 1952565079

Title

Owner

Phone

(708) 466-6443

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.

• Lori Q Chaib, PSY.D.

  • Clinical Psychologist
  • Redondo Beach, CA
  • NPI 1952565079
  NPD (past) Authorized official

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

{
    "created_epoch": "1278806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1629380290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 AVENUE B",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902774829",
            "telephone_number": "708-466-6443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9290 FOREST EDGE DR",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276680",
            "telephone_number": "708-466-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND WELL PSYCHOLOGICAL SERVICES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-11",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "CHAIB",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "Q.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-466-6443",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• William F Mieler, MD
• Tiffany Marie Migon, APN
• Jonathan L Miller, MD
• Samantha Mitchell
• Atef Moawad, M.D.
• Saeid Mojtahedi, MD.
• Ryan J. Molis, D.D.S.
• Alicia Ann Moore, MS,OTRL

• Clinical Psychologist in Burr Ridge, IL
• Providers in Burr Ridge, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; 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.