NPIMap

Organization Active NPI

Self Assembled Psychotherapy, PLLC

  • Mental Health Counselor
  • Chicago, IL
National Provider Identifier
1356064208
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SELF ASSEMBLED PSYCHOTHERAPY, PLLC
Practice address
5206 N Lind Ave
Chicago, IL 60630-1436
Phone
(608) 217-4711
NPI assigned
Sep 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Authorized official

Name
Katherine Jellinek Aldag, LCPC, NCCNPI 1760098966
Title
Founder & Bilingual Psychotherapist
Phone
(608) 217-4711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

5206 N Lind Ave
Chicago, IL 60630-1436

Mailing address

5206 N Lind Ave
Chicago, IL 60630-1436
Phone (608) 217-4711

Other identifiers 1

IdentifierTypeStateIssuer
1760098966OtherILLICENSED PROFESSIONAL COUNSELOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Kat@SelfAssebledPsychotherapy.com Direct

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: kat@selfassebledpsychotherapy.com

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666569600000",
    "number": "1356064208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5206 N LIND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606301436",
            "telephone_number": "608-217-4711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5206 N LIND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606301436",
            "telephone_number": "608-217-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF ASSEMBLED PSYCHOTHERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A",
        "authorized_official_last_name": "ALDAG",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "JELLINEK",
        "authorized_official_title_or_position": "FOUNDER & BILINGUAL PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "608-217-4711",
        "authorized_official_credential": "LCPC, NCC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR",
            "identifier": "1760098966",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kat@SelfAssebledPsychotherapy.com",
            "affiliation": "N",
            "endpointDescription": "E-Mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5206 N Lind Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606301436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.