Mitchell James Vansumeren, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20043294A Issued in IN

Practice address

10291 N Meridian St Ste 310
Indianapolis, IN 46290

Phone

(317) 672-1970

NPI assigned

Aug 14, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569542400000",
    "number": "1023534815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10291 N MERIDIAN ST STE 310",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901083",
            "telephone_number": "317-672-1970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10291 N MERIDIAN ST STE 310",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46290",
            "telephone_number": "317-672-1970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "355 W 16th St Ste 2800",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462022279",
            "country_code": "US",
            "telephone_number": "317-963-7300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "355 W 16th St Ste 2800",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462022279",
            "country_code": "US",
            "telephone_number": "317-963-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANSUMEREN",
        "first_name": "MITCHELL",
        "middle_name": "JAMES",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-08-14",
        "last_updated": "2019-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043294A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.