Provider Demographics
NPI:1275056897
Name:CLEAR MINDS BETTER LIVES PC
Entity type:Organization
Organization Name:CLEAR MINDS BETTER LIVES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDAL-RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-445-0995
Mailing Address - Street 1:PO BOX 47304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1431 N WESTERN AVE STE 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1775
Practice Address - Country:US
Practice Address - Phone:312-445-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty