Andrew B Mouton, PHD
Individual provider Active NPI Clinical Psychologist · Orland Park, IL
NPI 1477500825 · NPPES record last updated May 13, 2009
Key facts
- NPI
- 1477500825
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 071004325 (IL)
- Practice address
- 10640 W 165TH Street
Orland Park, IL 60467-5653 - Phone
- (708) 364-0261
- Fax
- (708) 364-6019
- NPI assigned
- May 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040202000455 | IL | Practitioner - Clinical Psychologist | 9133022866 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sigma Health PC | Clinical | Current |
Accepting new patients |
| Advanced Health Services, Inc. | Past |
Accepting new patients | |
| Advanced Health Services, Inc | Past |
Accepting new patients | |
| Advanced Health Services, Inc. | Past |
Accepting new patients |
Locations
900 Technology Way
Ste 120
Libertyville, IL 60048
Phone (708) 364-0269
10640 165th St
Orland Park, IL 60467
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071004325 | IL | Yes |
Addresses
Primary practice location
10640 W 165TH Street
Orland Park, IL 60467-5653
Mailing address
10640 W 165TH Street
Orland Park, IL 60467-5653
Phone (708) 364-0261
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071004325 | Other | IL | STATE LICENSE |
Other providers in Orland Park, IL
- Elaine Morrissey
- Tracey Mose
- Gail Patricia Mosey
- Motivated OT Mama PLLC
- Christine Marie Motsch
- Cathy Denise Moynihan
- Magdalena Mroczka
- Audrey Mrozckowski
- Melissa A Muchowicz
- Amyra H Muhammad
All providers in Orland Park, IL · Clinical Psychologist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.