Hyde Park Mental Wellness

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

HYDE PARK MENTAL WELLNESS

Practice address

1525 E 55TH St Ste 205
Chicago, IL 60615-5584

Phone

(773) 834-3561

Fax

(405) 307-7611

NPI assigned

Aug 19, 2019

Organization subpart

No

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

Authorized official

Name

Andrew Richardson, PMHNP-BC

Title

Owner

Phone

(773) 834-3561

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1566172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1114574886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E 55TH ST STE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606155584",
            "telephone_number": "773-834-3561",
            "fax_number": "405-307-7611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E 55TH ST STE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606155584",
            "telephone_number": "773-834-3561",
            "fax_number": "405-307-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HYDE PARK MENTAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-19",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-834-3561",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.