Tom Benike, LPC-IT

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3512-226 Issued in WI

Practice address

1499 6TH St
Green Bay, WI 54304-2252

Phone

(920) 497-6161

Fax

(920) 497-6161

NPI assigned

Jun 14, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Innovative Counseling Inc

  • Community/Behavioral Health Agency
  • Green Bay, WI
  • NPI 1093869588
  NPD (past)

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497398400000",
    "number": "1063942969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161",
            "fax_number": "920-497-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENIKE",
        "first_name": "TOM",
        "credential": "LPC-IT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-14",
        "last_updated": "2017-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3512-226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "3512-226",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn Allen Belverud, D.O.
• Michaela Kay Bemis, OT
• Rebecca Bemke, MS, SLP-CCC
• Heidi Ann Bemowski, PH.D.
• Paula L Benbow, D.C.
• Debra L Benishek, APNP
• William H Benn, MD
• Sara Jane Beno-Chambers, APNP
• Breanna Beno, APNP
• Donald J Beno, MD

• All providers in Green Bay, WI
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2017; 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.