NPIMap

Organization Active NPI

Marvelous Minds, Inc

  • Mental Health Counselor
  • Glen Ellyn, IL
National Provider Identifier
1902319916
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MARVELOUS MINDS, INC
Doing business as
Marvelous Minds Inc
Practice address
420 Pennsylvania Ave Ste 101
Glen Ellyn, IL 60137-4427
Phone
(630) 474-4353
Fax
(630) 790-8898
NPI assigned
Nov 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Authorized official

Name
Dr. Kymberly Fay Larson, PSYDNPI 1629491097
Title
President
Phone
(630) 474-4353

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

420 Pennsylvania Ave Ste 101
Glen Ellyn, IL 60137-4427

Mailing address

420 Pennsylvania Ave Ste 101
Glen Ellyn, IL 60137-4427
Phone (630) 474-4353

Other names 1

  • Marvelous Minds Inc Doing business as

National Provider Directory

National Provider Directory

Locations

420 Pennsylvania Ave
Ste 101
Glen Ellyn, IL 60137
Phone (630) 474-4353

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1902319916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 PENNSYLVANIA AVE STE 101",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374427",
            "telephone_number": "630-474-4353",
            "fax_number": "630-790-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 PENNSYLVANIA AVE STE 101",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374427",
            "telephone_number": "630-474-4353",
            "fax_number": "630-790-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVELOUS MINDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-13",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KYMBERLY",
        "authorized_official_middle_name": "FAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-474-4353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marvelous Minds Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.