NPIMap

Organization Active NPI

Samaritan Interfaith Counseling Center Inc.

  • Clinical Psychologist
  • Naperville, IL
National Provider Identifier
1497842983
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071-004701 Issued in IL
Legal business name
SAMARITAN INTERFAITH COUNSELING CENTER INC.
Practice address
1819 Bay Scott Cir Ste 109
Naperville, IL 60540-1130
Phone
(630) 357-2456
Fax
(630) 357-2482
NPI assigned
Oct 6, 2006
Last updated
Jun 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Scott Mitchell, PSY.DNPI 1215024757
Title
Executive Director
Phone
(630) 357-2456

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071-004701 IL Primary

Addresses

Primary practice location

1819 Bay Scott Cir Ste 109
Naperville, IL 60540-1130

Mailing address

1819 Bay Scott Cir Ste 109
Naperville, IL 60540-1130
Phone (630) 357-2456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041207000048 IL Part B Supplier - Clinic/Group Practice 8426014994 Receives reassigned benefits from 25 practitioners
Practice locations: Naperville, IL

National Provider Directory

National Provider Directory

Locations

1819 Bay Scott Cir
Ste 109
Naperville, IL 60540
Phone (630) 357-2456

Practitioners & affiliated clinicians

Practitioners 60

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.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1497842983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 BAY SCOTT CIR STE 109",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605401130",
            "telephone_number": "630-357-2456",
            "fax_number": "630-357-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 BAY SCOTT CIR STE 109",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605401130",
            "telephone_number": "630-357-2456",
            "fax_number": "630-357-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN INTERFAITH COUNSELING CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-357-2456",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071-004701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.