Mindful Brothers Collective Foundation

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MINDFUL BROTHERS COLLECTIVE FOUNDATION

Doing business as

Mindful Brothers Collective Foundation

Practice address

4250 N Marine Dr Ste 200
Chicago, IL 60613-1936

Phone

(773) 742-6684

NPI assigned

Oct 15, 2024

Last updated

Oct 15, 2024By 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

Mr. Thomas W Ivey, LCSWNPI 1548021447

Title

Ceo & Founder

Phone

(773) 742-6684

Specialties & licenses 1

Addresses

Other names 1

• Mindful Brothers Collective Foundation Doing business as

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.

• Thomas W. Ivey

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1548021447
  NPD Authorized official

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

{
    "created_epoch": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1669292595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 N MARINE DR STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131936",
            "telephone_number": "773-742-6684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 N MARINE DR STE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606131936",
            "telephone_number": "773-742-6684"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4250 N Marine Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606131936",
            "country_code": "US",
            "telephone_number": "773-742-6684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDFUL BROTHERS COLLECTIVE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "IVEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO & FOUNDER",
        "authorized_official_telephone_number": "773-742-6684",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mindful Brothers Collective Foundation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.