NPIMap

Individual provider Active NPI

Alisa Matteson Mundt, PSYD

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1598967705
Registry record updated Mar 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.007178 Issued in IL
Practice address
30 N Michigan Ave
Suite 925
Chicago, IL 60602-3463
Phone
(312) 540-8977
NPI assigned
Jun 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071.007178 IL Primary

Addresses

Primary practice location

30 N Michigan Ave
Suite 925
Chicago, IL 60602-3463

Mailing address

30 N Michigan Ave
Suite 925
Chicago, IL 60602-3463
Phone (312) 540-8977

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
071.007178ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Aspen Center for Counseling and Consultation, LLC Past Accepting new patients
The Aspen Center for Counseling and Consultation LLC Clinical Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301529600000",
    "number": "1598967705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE",
            "address_2": "SUITE 925",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023463",
            "telephone_number": "312-540-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE",
            "address_2": "SUITE 925",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023463",
            "telephone_number": "312-540-8977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNDT",
        "first_name": "ALISA",
        "middle_name": "MATTESON",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2011-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Mar 31, 2011; 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.