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MIND REVIVAL PSYCH INC
NPI 1043182280
Nurse Practitioner - Psychiatric/Mental Health in Chicago, IL

Active since September 18, 2025
7201 S STONY ISLAND AVE # 7, CHICAGO, IL 60649(773) 690-5300(870) 201-4835 Get Directions Write a Review

NPPES record last updated: December 12, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 12, 2025, Sep 18, 2025 (2 updates tracked since 2025).

About Mind Revival Psych Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIND REVIVAL PSYCH INC (NPI 1043182280) is a healthcare organization registered as a psychiatric/mental health in Chicago, Illinois and active in the NPI registry since September 2025. The organization maintains a secondary practice location in Chicago and lists Ebonie Williams, Np/owner, as its authorized official.

NPPES Registry Identity

NPI1043182280
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameMIND REVIVAL PSYCH INC
Location Address7201 S STONY ISLAND AVE # 7Chicago, IL 60649-2806
Mailing Address7201 S Stony Island Ave # 7Chicago, IL 60649-2806 · (773) 690-5300 · Fax (870) 201-4835
Phone(773) 690-5300
Fax(870) 201-4835
Organization SubpartNo
Authorized OfficialEbonie WilliamsNp/owner · (708) 715-2035
Enumeration DateSeptember 18, 2025
Last NPPES UpdateDecember 12, 20252 updates tracked since enumeration
NPPES CertifiedDecember 12, 2025
✔ NPI 1043182280 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
7201 S STONY ISLAND AVE # 7, Chicago, IL 60649
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Secondary Practice Location 1

Location 11918 W Irving Park RdChicago, IL 60613-6267 · Phone (773) 690-5300 · Fax (870) 201-4835

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mind Revival Psych Inc's NPI number?

The NPI number for Mind Revival Psych Inc is 1043182280. It was assigned to this organization in the NPPES registry on September 18, 2025.

Where is Mind Revival Psych Inc located?

Mind Revival Psych Inc is located at 7201 S Stony Island Ave # 7, Chicago, IL 60649. The listed phone number is (773) 690-5300.

What is Mind Revival Psych Inc's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

When was this NPI record last updated?

The NPPES record for Mind Revival Psych Inc was last updated on December 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.