Amanda Wittmer, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178.017229 Issued in IL

Practice address

30 N Michigan Ave Ste 424
Chicago, IL 60602-3844

Phone

(260) 355-7043

Fax

(312) 841-8866

NPI assigned

Mar 9, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mindbodycoop.amandawittmer@147350.advancedmd-direct.com
• Direct secure messaging: mindbodycoop.meredithraque@147350.advancedmd-direct.com

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.

• Mind Body Co-Op

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1750668091
  NPD

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

{
    "created_epoch": "1646784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1861149882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4507 N RAVENSWOOD AVE STE 111",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE STE 424",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023844",
            "telephone_number": "260-355-7043",
            "fax_number": "312-841-8866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTMER",
        "first_name": "AMANDA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.017229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS LICENSING BOARD",
            "identifier": "178.017229",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MINDBODYCOOP.MEREDITHRAQUE@147350.ADVANCEDMD-DIRECT.COM",
            "affiliation": "N",
            "endpointDescription": "AMD-MEREDITH",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "30 N Michigan Ave Ste 424",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606023844",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MindBodyCoop.amandawittmer@147350.advancedmd-direct.com",
            "affiliation": "N",
            "endpointDescription": "amd",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "30 N Michigan Ave Ste 424",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606023844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Molly Romer Witten, PH.D.
• Skylar Maya Wittenberg, LCPC
• Matthew Charles Witthaus, M.D.
• Evan Wittke, MD
• Noam E. Wittlin, PH.D.
• Jeffrey Stephen Wittmus, D.D.S.
• Gloria Wittum, RN
• Marjorie Witty, PH.D.
• Holly Witvoet
• Susan R. Witz, R.D., L.D.

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, 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 Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.