NORTHEAST WISCONSIN BEHAVIORAL HEALTH SC NPI 1275733602

NPI Information

NPI: 1275733602
Provider Name: NORTHEAST WISCONSIN BEHAVIORAL HEALTH SC
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

Address:
529 SOUTH JEFFERSON STREET
SUITE 202
GREEN BAY, WI
ZIP 54301
Phone: (920) 884-2175
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NORTHEAST WISCONSIN BEHAVIORAL HEALTH SC is a mental health counselor in Green Bay, WI. NORTHEAST WISCONSIN BEHAVIORAL HEALTH SC NPI is 1275733602. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

529 SOUTH JEFFERSON STREET
SUITE 202
GREEN BAY, WI
ZIP 54301-125
Phone: (920) 884-2175
Fax: (920) 884-6735

The provider's authorized official is Suzette Marie Kosnar-tittl .
The authorized official title is Owner, Ceo, Provider and has the following contact phone number (920) 884-2175.

The enumeration date for this NPI number is 7/24/2007 and was last updated on 10/16/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health	4044-123	WISCONSIN	No
2	101YP2500X	Counselor	Professional	2376 125	WISCONSIN	No
3	1041C0700X	Social Worker	Clinical	4044 123	WISCONSIN	No
4	106H00000X	Marriage & Family Therapist		489 124	WISCONSIN	No
5	101YM0800X	Counselor	Mental Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	39722900	OTHER	WISCONSIN	PROVIDER MEDICAID #
2	000044900	OTHER	WISCONSIN	CLINICMEDICARE# GREENBAY
3	1275733602	OTHER	WISCONSIN	CLINIC NPI#
4	000044905	OTHER	WISCONSIN	CLINICMEDICARE#OSHKOSH
5	1285736249	OTHER		PROVIDER NPI
6	000144900	OTHER	WISCONSIN	PROVIDERMEDICARE#GREENBAY
7	000144905	OTHER	WISCONSIN	PROVIDERMEDICARE#OSHKOSH
8	4225100	OTHER	WISCONSIN	CLINIC MEDICAID #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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