Elysian Mental Health

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

ELYSIAN MENTAL HEALTH

Practice address

708 Church St Ste 223
Evanston, IL 60201-3881

Phone

(989) 326-5621

NPI assigned

Sep 21, 2024

Organization subpart

No

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

Authorized official

Name

Cassidy R BuckelewNPI 1518699768

Title

Psychologist, Owner

Phone

(708) 292-8373

Specialties & licenses 1

Addresses

Tax ID family

Cassidy Buckelew PSYD LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cassidy Buckelew PSYD LLC

  • Clinical Psychologist
  • Evanston, IL
  • NPI 1902781792
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cassidy Buckelew, PSY.D

  • Clinical Psychologist
  • Evanston, IL
  • NPI 1518699768
  NPD Authorized official

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

{
    "created_epoch": "1726876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1124845235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 CHURCH ST STE 223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013881",
            "telephone_number": "989-326-5621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 CHURCH ST STE 223",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013881",
            "telephone_number": "989-326-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELYSIAN MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-21",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "BUCKELEW",
        "authorized_official_first_name": "CASSIDY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PSYCHOLOGIST, OWNER",
        "authorized_official_telephone_number": "708-292-8373"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Khaliah Yvonne Elliston
• Elsa Gould Physical Therapy PLLC
• Alexandra Lee Elstein, PSYD
• Sarah Elster
• Rachel L Elwell, MD
• Linda Emanuel, M.D., PH.D.
• Cary Leonard Emard Klemmer, PH.D., LCSW
• Embodied Healing Counseling and Yoga
• Embodied Practice Therapy, PLLC
• James Embrescia, D.O.

• Clinical Psychologist in Evanston, IL
• Providers in Evanston, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.