NPIMap

Organization Active NPI

Mind Body Co-Op

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1770174559
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MIND BODY CO-OP
Practice address
30 N Michigan Ave Ste 424
Chicago, IL 60602-3844
Phone
(312) 279-9981
Fax
(312) 279-9981
NPI assigned
Feb 3, 2021
Organization subpart
Yes
Parent organization
MIND BODY CO-OPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

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

Authorized official

Name
Kellie Rice, PSY.D., CGPNPI 1891002242
Title
Founder/Ceo
Phone
(312) 279-9981

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133N00000X
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Obesity and Weight Management Nutrition Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133VN1201X
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X
Electrodiagnostic Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204R00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

30 N Michigan Ave Ste 424
Chicago, IL 60602-3844

Mailing address

3209 N Lakewood Ave
Chicago, IL 60657-3215
Phone (872) 274-4344

Other practice location 1

3209 N Lakewood Ave
Chicago, IL 60657-3215
Phone (872) 274-4344

Other identifiers 1

IdentifierTypeStateIssuer
1750668091MedicaidIL

Other names 1

  • Mind Body Co-op Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mindbodycoop.emilyberwald@147350.advancedmd-direct.com Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Mind Body Co-Op2 organizations share this tax ID, including this one
Part of
Mind Body Co-Op

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3209 N Lakewood Ave
Chicago, IL 60657
Phone (312) 279-9981

30 N Michigan Ave
Ste 424
Chicago, IL 60602
Phone (312) 279-9981

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1770174559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 N LAKEWOOD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573215",
            "telephone_number": "872-274-4344",
            "fax_number": "866-671-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE STE 424",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023844",
            "telephone_number": "312-279-9981",
            "fax_number": "312-279-9981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3209 N Lakewood Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606573215",
            "country_code": "US",
            "telephone_number": "872-274-4344",
            "fax_number": "866-671-9991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIND BODY CO-OP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIND BODY CO-OP",
        "enumeration_date": "2021-02-03",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "FOUNDER/CEO",
        "authorized_official_telephone_number": "312-279-9981",
        "authorized_official_credential": "PSY.D.,  CGP"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133VN1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750668091",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mindbodycoop.emilyberwald@147350.advancedmd-direct.com",
            "affiliation": "N",
            "endpointDescription": "Mind Body Co-op",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA",
            "address_1": "3209 N Lakewood Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606573215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mind Body Co-op",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.