Kintsugi Mental Health LLC

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Legal business name

KINTSUGI MENTAL HEALTH LLC

Practice address

119 Martin Luther King Jr Blvd Ste LL-20
Madison, WI 53703-3355

Phone

(608) 291-3586

NPI assigned

Jan 30, 2024

Organization subpart

No

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

Authorized official

Name

Jaime Lam, PHD, LPNPI 1932684735

Title

Owner/Licensed Psychologist

Phone

(781) 698-9171

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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.

• Jaime Lam, PHD, LP

  • Counseling Psychologist
  • Madison, WI
  • NPI 1932684735
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1679336077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5902 TOLMAN TER",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537113360",
            "telephone_number": "781-698-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 MARTIN LUTHER KING JR BLVD STE LL-20",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033355",
            "telephone_number": "608-291-3586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5902 Tolman Ter",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537113360",
            "country_code": "US",
            "telephone_number": "781-698-9171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KINTSUGI MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "OWNER/LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "781-698-9171",
        "authorized_official_credential": "PHD, LP"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Phyllis Kinney, LCSW
• Suzanne Kinney, OTR
• Angel Kinnie
• William James Kinsey, MD
• Lauren Kinstler, MS, CCC-SLP
• Timothy R Kinzel, D.D.S.
• Michael Kinzler
• Quinith Kipchumba, MD
• John Daniel Kipp, DPT
• Ryan T Kipp, M.D.

• Counseling Psychologist in Madison, WI
• Providers in Madison, WI by specialty
• Counseling Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; 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.