NPI |
1487368908 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Organization Name Legal Business Name |
BURCHBY COUNSELING INC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
40 JEWELERS PARK DR STE 100 |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Business Practice Location Address City Name |
NEENAH |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
WI |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
549563893 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Telephone Number |
9202450087 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
2622085321 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
1/9/2023 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
1/9/2023 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Last Name |
BURCHBY |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
DANEL |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official Title or Position |
LCSW |
The title or position of the authorized official. |
Authorized Official Telephone Number |
9202450087 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
251S00000X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
100165489 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
05 |
|
Other Provider Identifier State 1 |
WI |
|
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
LCSW |
|
NPI Certification Date |
1/9/2023 |
|