Protean Archetypes LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

PROTEAN ARCHETYPES LLC

Practice address

29 S Webster St Ste 290D
Naperville, IL 60540-5356

Phone

(630) 632-5069

NPI assigned

Nov 16, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Mary Holland, PSY.D.NPI 1548793672

Title

Licensed Clinical Psychologist/Owne

Phone

(630) 632-5069

Specialties & licenses 1

Addresses

Other names 1

• Protean Archetypes LLC Other name

Practitioners 1

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

• Mary Holland, PSY.D.

  • Psychologist
  • Oakbrook Terrace, IL
  • NPI 1548793672
  NPD Authorized official

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

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1316712656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8928 MIDDLETON RD",
            "city": "DARIEN",
            "state": "IL",
            "postal_code": "605618441",
            "telephone_number": "630-632-5069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 S WEBSTER ST STE 290D",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605405356",
            "telephone_number": "630-632-5069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6401 Clarendon Hills Rd Apt 305",
            "address_purpose": "LOCATION",
            "city": "Willowbrook",
            "state": "IL",
            "postal_code": "605272119",
            "country_code": "US",
            "telephone_number": "630-632-5069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROTEAN ARCHETYPES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-16",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST/OWNE",
        "authorized_official_telephone_number": "630-632-5069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Protean Archetypes LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Protean Archetypes LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Psychologist in Naperville, IL
• Providers in Naperville, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.