Individual provider Active NPI

Tina M Griffith

  • Professional Counselor
  • Green Bay, WI
National Provider Identifier
1063072585
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
7209 Issued in WI
Practice address
2640 W Point Rd
Green Bay, WI 54304-1344
Phone
(920) 490-3790
NPI assigned
Jun 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 7209 WI Primary

Addresses

Primary practice location

2640 W Point Rd
Green Bay, WI 54304-1344

Mailing address

PO Box 365
Oneida, WI 54155-0365
Phone (920) 490-3790

Other practice location 1

600 N Westhaven Dr
Oshkosh, WI 54904-6926
Phone (920) 720-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20260223000685 FL Practitioner - Mental Health Counselor 3779971106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Brave Health Inc.Group PAC ID 8123458981, 112 clinicians

Practice addresses (Care Compare)

13934 Painted Bunting LN
Riverview, FL 33579-3525
Phone (305) 902-6347

1951 NW 7TH Ave
FL 3
Miami, FL 33136-1104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Brave Health Inc. CurrentSince Feb 2, 2026 Accepting new patients
Oneida Nation Past Accepting new patients

Organizations & group practices 2

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": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1063072585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541550365",
            "telephone_number": "920-490-3790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 W POINT RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543041344",
            "telephone_number": "920-490-3790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 N Westhaven Dr",
            "address_purpose": "LOCATION",
            "city": "Oshkosh",
            "state": "WI",
            "postal_code": "549046926",
            "country_code": "US",
            "telephone_number": "920-720-2300",
            "fax_number": "920-237-5616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIFFITH",
        "first_name": "TINA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.