1336301969 NPI number — JXP HEALTHY MINDS PC

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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".




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