NPIMap

Organization Active NPI

Innovative Counseling Inc

  • Community/Behavioral Health Agency
  • Green Bay, WI
National Provider Identifier
1093869588
Registry record updated Mar 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2283 Issued in WI
Legal business name
INNOVATIVE COUNSELING INC
Practice address
1499 6TH St
Innovative Counseling Inc
Green Bay, WI 54304-2252
Phone
(920) 497-6161
Fax
(920) 498-0476
NPI assigned
Jan 22, 2007
Last updated
Mar 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2010

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

Authorized official

Name
Ms. Cynthia Rae Thomas, MSW ACSWNPI 1780868125
Title
Clinical Director
Phone
(920) 497-6161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 2283 WI Primary

Addresses

Primary practice location

1499 6TH St
Innovative Counseling Inc
Green Bay, WI 54304-2252

Mailing address

1499 6TH St
Innovative Counseling Inc
Green Bay, WI 54304-2252
Phone (920) 497-6161

Other identifiers 2

IdentifierTypeStateIssuer
42207500MedicaidWI
WI1391MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091012000203 WI Part B Supplier - Clinic/Group Practice 8022154749 Receives reassigned benefits from 20 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Locations

1499 6th St
Green Bay, WI 54304
Phone (920) 497-6161

2339 Cedar Rdg
Green Bay, WI 54313
Phone (920) 497-6161

Practitioners & affiliated clinicians

Practitioners 92

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.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1093869588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "address_2": "INNOVATIVE COUNSELING INC",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161",
            "fax_number": "920-498-0476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "address_2": "INNOVATIVE COUNSELING INC",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161",
            "fax_number": "920-498-0476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE COUNSELING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "920-497-6161",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW ACSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "2283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42207500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "WI1391",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.