Individual provider Active NPI

Lisa Jeanne Mull, PSYD

  • Clinical Psychologist
  • Usaf Academy, CO
National Provider Identifier
1043332349
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3317 Issued in CO
Practice address
4102 Pinion Dr
Usaf Academy, CO 80840-2502
Phone
(719) 333-5154
NPI assigned
Apr 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3317 CO Primary

Addresses

Primary practice location

4102 Pinion Dr
Usaf Academy, CO 80840-2502

Mailing address

4102 Pinion Dr
Usaf Academy, CO 80840-2502
Phone (719) 333-5154

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210616000519 MI Practitioner - Clinical Psychologist 2668872441 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3225 N Evergreen Dr
Pine Rest Northeast Clinic
Grand Rapids, MI 49525-9334
Phone (616) 364-1500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3317COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince May 23, 2021 Accepting new patients
Pine Rest Christian Mental Health Services Psychologist CurrentSince May 23, 2021 Accepting new patients

Locations

3225 N Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 364-1500

4211 Parkway Place Dr SW
Grandville, MI 49418
Phone (616) 222-3700

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242777600000",
    "number": "1043332349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 PINION DR",
            "city": "USAF ACADEMY",
            "state": "CO",
            "postal_code": "808402502",
            "telephone_number": "719-333-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 PINION DR",
            "city": "USAF ACADEMY",
            "state": "CO",
            "postal_code": "808402502",
            "telephone_number": "719-333-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULL",
        "first_name": "LISA",
        "middle_name": "JEANNE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2009-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "3317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Usaf Academy, CO

Sources for this page

Verify at the official NPI Registry.