| Mindvault Health, Llc | |
|
5541 E Lake Dr Apt E Lisle IL 60532-2679 | |
| (630) 384-9214 | |
| Not Available |
| Full Name | Mindvault Health, Llc |
|---|---|
| Speciality | Counselor |
| Location | 5541 E Lake Dr Apt E, Lisle, Illinois |
| Authorized Official Name and Position | Todd Mokos (OWNER) |
| Authorized Official Contact | 6303849214 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindvault Health, Llc 5541 E Lake Dr Apt E Lisle IL 60532-2679 Ph: (630) 384-9214 | Mindvault Health, Llc 5541 E Lake Dr Apt E Lisle IL 60532-2679 Ph: (630) 384-9214 |
| NPI Number | 1689321945 |
|---|---|
| Provider Enumeration Date | 03/07/2022 |
| Last Update Date | 03/07/2022 |
| Certification Date | 03/07/2022 |
| Medicare PECOS PAC ID | 0345627063 |
|---|---|
| Medicare Enrollment ID | O20220519000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689321945 | NPI | - | NPPES |
| Provider Name | Todd Patrick Mokos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720321854 PECOS PAC ID: 4183900756 Enrollment ID: I20170413001607 |
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