Provider Type Icon

CHILDREN'S MEDICAL GROUP INC. NPI 1245017201


NPI Information

NPI: 1245017201
Provider Name: CHILDREN'S MEDICAL GROUP, INC.

Doing Business As: KENOSHA MENTAL HEALTH WALK-IN CLINIC

Classification: Social Worker - 1041C0700X
Entity Type: Organization

Specialization: Clinical

Address:
6809 122ND AVE
KENOSHA, WI
ZIP 53142
Phone: (262) 891-6575
Get Directions

CHILDREN'S MEDICAL GROUP, INC. is a clinical social worker in Kenosha, WI. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. CHILDREN'S MEDICAL GROUP, INC. NPI is 1245017201. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Kenosha Mental Health Walk-in Clinic.

The provider's business location address is:

6809 122ND AVE
KENOSHA, WI
ZIP 53142-335
Phone: (262) 891-6575
Fax: (262) 654-5467

The provider's authorized official is Sheila Reuteman .
The authorized official title is Sr. Credentialing Coordinator and has the following contact phone number (414) 266-7615.

The enumeration date for this NPI number is 9/13/2023 and was last updated on 9/13/2023.


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
1106H00000XMarriage & Family TherapistNo
22084P0800XPsychiatry & NeurologyPsychiatryNo
32084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryNo
4261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
5101YM0800XCounselorMental HealthNo
6101YP2500XCounselorProfessionalNo
7104100000XSocial WorkerNo
81041C0700XSocial WorkerClinicalYes

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
11245017201MEDICAIDWISCONSIN

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: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.