Individual provider Active NPI

Chloe Schulz, LPC

  • Professional Counselor
  • West Bend, WI
National Provider Identifier
1073096707
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
7055-125 Issued in WI
Practice address
400 W River Dr
West Bend, WI 53090-1518
Phone
(262) 334-4340
Fax
(262) 334-4341
NPI assigned
Sep 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 7055-125 WI
Mental Health Counselor 101YM0800X 7055-125 WI
Professional Counselor 101YP2500X 7055-125 WI Primary

Addresses

Primary practice location

400 W River Dr
West Bend, WI 53090-1518

Mailing address

400 W River Dr
West Bend, WI 53090-1518
Phone (262) 334-4340

Other identifiers 1

IdentifierTypeStateIssuer
1073096707MedicaidWI

Other names 1

  • Chloe Lewis Former name

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
I20240502003058 WI Practitioner - Mental Health Counselor 0345680674 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7055-125WIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kettle Moraine Counseling LLC CurrentSince Mar 19, 2024 Accepting new patients
Professional Services Group, Inc. Mental Health PastSince Dec 1, 2016 Accepting new patients
Affiliated Clinical Services Inc PastSince Dec 22, 2019 Accepting new patients

Locations

400 W River Dr
West Bend, WI 53090
Phone (262) 334-4340

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": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1073096707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W RIVER DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530901518",
            "telephone_number": "262-334-4340",
            "fax_number": "262-334-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W RIVER DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530901518",
            "telephone_number": "262-334-4340",
            "fax_number": "262-334-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULZ",
        "first_name": "CHLOE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-10",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WI",
            "license": "7055-125",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "7055-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7055-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073096707",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHLOE",
            "last_name": "LEWIS",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.