Active NPI
Mimi Neathery, PSYD
- Clinical Psychologist
- Chicago, IL
National Provider Identifier
1821429515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.008698
- Practice address
- 650 N Dearborn St
Suite 400
Chicago, IL 60654-3873 - Phone
- (773) 580-9121
- Fax
- (312) 291-9723
- NPI assigned
- Dec 5, 2013
- Last updated
- Dec 9, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.008698 | IL | Primary |
Addresses
Primary practice location
650 N Dearborn St
Suite 400
Chicago, IL 60654-3873
Mailing address
650 N Dearborn St
Suite 400
Chicago, IL 60654-3873
Phone (773) 580-9121
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
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008698 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Counseling and Diagnostic Center | Past | Accepting new patients | |
| Midwest Counseling and Diagnostic Center | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Social Worker
- Chicago, IL
- NPI 1245621242
-
- Addiction (Substance Use Disorder) Counselor
- Chicago, IL
- NPI 1679914584
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418083200000",
"number": "1821429515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 N DEARBORN ST",
"address_2": "SUITE 400",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543873",
"telephone_number": "773-580-9121",
"fax_number": "312-291-9723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 N DEARBORN ST",
"address_2": "SUITE 400",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543873",
"telephone_number": "773-580-9121",
"fax_number": "312-291-9723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEATHERY",
"first_name": "MIMI",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-05",
"last_updated": "2014-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.008698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
- Near North Health Service Corporation
- Near North Health Service Corporation (Razem Health Center)
- Edriana Veizi Nearing, PA-C
- Mary Kate Elizabeth Neary
- Michael John Neary Jr., M.S., CCC-SLP
- Sarah H Neault, B.S.N., M.S.
- Jennifer A Nebel
- Megan Neberz, LCPC
- Jai Nebhrajani, M.D.
- Julie Marie Neborak, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.