Individual provider Active NPI

Tiffany Michele Bellamy, PSYD

  • Mental Health Counselor
  • Oak Brook, IL
National Provider Identifier
1740816362
Registry record updated Mar 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
178.009052 Issued in IL
Practice address
2021 Midwest Rd Ste 100C
Oak Brook, IL 60523-1394
Phone
(708) 224-8305
NPI assigned
Mar 15, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 178.009052 IL Primary

Addresses

Primary practice location

2021 Midwest Rd Ste 100C
Oak Brook, IL 60523-1394

Mailing address

510 Bonnie Brae PL Apt L1
River Forest, IL 60305-1946
Phone (708) 205-7369

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
178.009052ILMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Diverse Legacy Incorporated CurrentSince Aug 8, 2024 Accepting new patients
TMB Behavioral Health Solutions, PLLC Mental Health Current Accepting new patients

Locations

2021 Midwest Rd
Ste 100C
Oak Brook, IL 60523
Phone (708) 223-8405

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1584230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584230400000",
    "number": "1740816362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 BONNIE BRAE PL APT L1",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051946",
            "telephone_number": "708-205-7369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 MIDWEST RD STE 100C",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231394",
            "telephone_number": "708-224-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLAMY",
        "first_name": "TIFFANY",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-15",
        "last_updated": "2020-03-15",
        "certification_date": "2020-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.009052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Brook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2020; 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.