NPIMap

Organization Active NPI

Different Shades of Healing, LLC

Doing business as Different Shades of Healing

  • Adolescent and Children Mental Health Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1033772058
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
DIFFERENT SHADES OF HEALING, LLC
Doing business as
Different Shades of Healing
Practice address
6830 W Villard Ave Ste 190
Milwaukee, WI 53218-3968
Phone
(262) 320-7886
NPI assigned
Apr 16, 2019
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
Nastassia Jackson, LPC-ITNPI 1720524341
Title
Therapist/Owner
Phone
(414) 265-6156

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

6830 W Villard Ave Ste 190
Milwaukee, WI 53218-3968

Mailing address

4752 N 78TH CT
Milwaukee, WI 53218-4643

Other identifiers 1

IdentifierTypeStateIssuer
100071680MedicaidWI

Other names 1

  • Different Shades of Healing Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dsohealing@outlook.com

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": "1555372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555372800000",
    "number": "1033772058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4752 N 78TH CT",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532184643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6830 W VILLARD AVE STE 190",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532183968",
            "telephone_number": "262-320-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIFFERENT SHADES OF HEALING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-16",
        "last_updated": "2019-04-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "NASTASSIA",
        "authorized_official_title_or_position": "THERAPIST/OWNER",
        "authorized_official_telephone_number": "414-265-6156",
        "authorized_official_credential": "LPC-IT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100071680",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dsohealing@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "address_1": "6830 W Villard Ave Ste 190",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532183968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Different Shades of Healing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

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.