NPIMap

Organization Active NPI

Plum Tree Psychology LTD

Doing business as Plum Tree Child & Adolescent Psychology

  • Clinical Child & Adolescent Psychologist
  • St Charles, IL
National Provider Identifier
1962954495
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
071007631 Issued in IL
Legal business name
PLUM TREE PSYCHOLOGY LTD
Doing business as
Plum Tree Child & Adolescent Psychology
Practice address
511 Illinois Ave
Saint Charles, IL 60174-2152
Phone
(630) 549-6245
Fax
(630) 701-9500
NPI assigned
Nov 1, 2016
Last updated
Apr 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2019

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

Authorized official

Name
Dr. Ann Weller, PSYDNPI 1194020560
Title
Owner
Phone
(630) 549-6245

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC2200X 071007631 IL Primary

Addresses

Primary practice location

511 Illinois Ave
Saint Charles, IL 60174-2152

Mailing address

511 Illinois Avenue
Saint Charles, IL 60174
Phone (630) 549-6245

Other names 1

  • Plum Tree Child & Adolescent Psychology Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555372800000",
    "number": "1962954495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 ILLINOIS AVENUE",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-549-6245",
            "fax_number": "630-701-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 ILLINOIS AVE",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601742152",
            "telephone_number": "630-549-6245",
            "fax_number": "630-701-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLUM TREE PSYCHOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-01",
        "last_updated": "2019-04-16",
        "status": "A",
        "authorized_official_last_name": "WELLER",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-549-6245",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071007631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plum Tree Child & Adolescent Psychology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Plum Tree Child & Adolescent Psychology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; 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.