Tanja Nicole Mundt, MA, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

17307 Issued in AZ

Practice address

4765 S Lakeshore Dr
Tempe, AZ 85282-7197

Phone

(913) 904-8565

NPI assigned

Apr 28, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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

• Revive Behavioral Health, LLC

  • Counselor
  • Gilbert, AZ
  • NPI 1346937588
  NPD Authorized official
• Copper Valley Health, LLC

  dba Copper Valley Health

  • Multi-Specialty Clinic/Center
  • Gilbert, AZ
  • NPI 1871382606
  NPD (past) Authorized official
• The Stone Community Health Center, LLC

  • Clinic/Center
  • Mesa, AZ
  • NPI 1801644521
  NPD (past)

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1356585715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4765 S LAKESHORE DR",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827197",
            "telephone_number": "913-904-8565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4765 S LAKESHORE DR",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852827197",
            "telephone_number": "913-904-8565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1232 E Broadway Rd",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852821511",
            "country_code": "US",
            "telephone_number": "913-904-8565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUNDT",
        "first_name": "TANJA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "MA, LPC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-28",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2007008419",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "17307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mulligan's Manor, Inc.
• Rebecca Mullins, M.A. CCC - SLP
• Elizabeth Mullnix, ATC
• Multispecialty Group of Flagstaff
• Magimvuyu N Mumbere, NP
• Kimberly Munneke, NP-BC
• Eric Paul Munson, ACT, CSCS, NASM-PES
• Leif Munson, PHARMD
• Kristine Murdock, PMHNP
• Juan Murillo Jr., LPC

• Professional Counselor in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.