1336301969 NPI number — JXP HEALTHY MINDS PC

Table of content: (NPI 1336301969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336301969 NPI number — JXP HEALTHY MINDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JXP HEALTHY MINDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JXP HEALTHY MINDS PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336301969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 N ASHLAND AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60622-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-492-8081
Provider Business Mailing Address Fax Number:
312-492-8083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
819 N ASHLAND AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-492-8081
Provider Business Practice Location Address Fax Number:
312-492-8083
Provider Enumeration Date:
06/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
XIQUES-PRIETO
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
LICENSED CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
312-492-8081

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  071006196 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1831260025 . This is a "JULIE A XIQUES-PRIETO PSY,D" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1184607608 . This is a "MERCEDEZ MARTINEZ MD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".