Inner Mission LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.009077 Issued in IL

Legal business name

INNER MISSION LLC

Practice address

801 E Main St
St Charles, IL 60174-2294

Phone

(630) 800-5207

Fax

(630) 820-0170

NPI assigned

Aug 27, 2015

Organization subpart

No

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

Authorized official

Name

Kristin A Hultgren, MANPI 1770964074

Title

LCPC, Owner

Phone

(630) 800-5207

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin Hultgren, LCPC

  • Mental Health Counselor
  • St Charles, IL
  • NPI 1770964074
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440633600000",
    "number": "1609243492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E MAIN ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742294",
            "telephone_number": "630-800-5207",
            "fax_number": "630-820-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E MAIN ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742294",
            "telephone_number": "630-800-5207",
            "fax_number": "630-820-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER MISSION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-27",
        "last_updated": "2015-08-27",
        "status": "A",
        "authorized_official_last_name": "HULTGREN",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "LCPC, OWNER",
        "authorized_official_telephone_number": "630-800-5207",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.009077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in St Charles, IL
• Providers in St Charles, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; 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.