Intermind Wellness Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

INTERMIND WELLNESS INC

Practice address

1137 W 127TH St
Calumet Park, IL 60827-6537

Phone

(312) 967-7214

NPI assigned

Mar 14, 2024

Last updated

Mar 14, 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

Stacey Davis, APRNNPI 1508454448

Title

Ceo

Phone

(312) 967-7214

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, and the practitioner matching its NPPES authorized official.

• Stacey Davis, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Oak Park, IL
  • NPI 1508454448
  NPD Authorized official

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

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1710746672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 W 127TH ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276537",
            "telephone_number": "312-967-7214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1137 W 127TH ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276537",
            "telephone_number": "312-967-7214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMIND WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-967-7214",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "",
            "desc": "Integrative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Greenfield, FNP-BC
• Lonyah Monquie Guy, APRN
• Raegene Hankle, FNP-BC
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• Tonya Hicks
• International Word Out Ministries
• Kenyana T Johnson, DEVELOPMENTAL THERAP
• Steven Vernon Johnson Jr., CDL CLASS A
• Tracey Johnson
• Lolita a. Wilburn D.C.P.C. (Back To Heatlh Chiropractic-Medical Center)

• Psychiatry Physician in Calumet Park, IL
• Providers in Calumet Park, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.