Individual provider Active NPI

Cerissa Jean Wills, LMFT

  • Marriage & Family Therapist
  • Madison, WI
National Provider Identifier
1023301512
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
871124 Issued in WI
Practice address
831 E Washington Ave
Madison, WI 53703-2935
Phone
(608) 255-7356
Fax
(608) 255-0457
NPI assigned
May 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 871124 WI Primary

Addresses

Primary practice location

831 E Washington Ave
Madison, WI 53703-2935

Mailing address

2801 International LN Ste 207
Madison, WI 53704-3152
Phone (608) 228-4610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240821000646 WI Practitioner - Marriage and Family Therapist 6901344191 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
871124WIMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Vibrations Mental Health LLC CurrentSince May 4, 2024 Accepting new patients
The Rainbow Project Inc Past Accepting new patients
The Rainbow Project, Inc. Past Accepting new patients

Locations

2801 International Ln
Ste 207
Madison, WI 53704
Phone (608) 228-4610

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1023301512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 INTERNATIONAL LN STE 207",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537043152",
            "telephone_number": "608-228-4610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 E WASHINGTON AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537032935",
            "telephone_number": "608-255-7356",
            "fax_number": "608-255-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "CERISSA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-17",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "871124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.