1104675404 NPI number — JOURNEY OF HEALING LLC

Table of content: DR. NAUREEN MULLANI MD, MS (NPI 1396372728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104675404 NPI number — JOURNEY OF HEALING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOURNEY OF HEALING LLC
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:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104675404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21720 W LONG GROVE RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEER PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010-3752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9730 S WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERGREEN PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60805-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-696-4874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
BRINYEL
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official Telephone Number:
708-696-4874

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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