NPIMap

Organization Active NPI

Integrated Counseling Center LLC

  • Clinical Social Worker
  • Fond Du Lac, WI
National Provider Identifier
1104053701
Registry record updated Jun 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
7003-123 Issued in WI
Legal business name
INTEGRATED COUNSELING CENTER LLC
Practice address
N6687 Wrightway Dr Ste D
Fond Du Lac, WI 54937-8433
Phone
(920) 929-9140
Fax
(920) 929-9142
NPI assigned
Jun 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2009

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

Authorized official

Name
Rosonna Sue Comers, LCSWNPI 1467591131
Title
Owner
Phone
(920) 929-9140

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 29-036 WI
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 2270-057 WI
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 7003-123 WI Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 7209-123 WI

Addresses

Primary practice location

N6687 Wrightway Dr Ste D
Fond Du Lac, WI 54937-8433

Mailing address

N6687 Wrightway Dr Ste D
Fond Du Lac, WI 54937-8433
Phone (920) 929-9140

Other identifiers 1

IdentifierTypeStateIssuer
422-43800MedicaidWI

National Provider Directory

National Provider Directory

Locations

N6687 Wrightway Dr
Ste D
Fond du Lac, WI 54937
Phone (920) 929-9140

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245628800000",
    "number": "1104053701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N6687 WRIGHTWAY DR STE D",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549378433",
            "telephone_number": "920-929-9140",
            "fax_number": "920-929-9142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N6687 WRIGHTWAY DR STE D",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549378433",
            "telephone_number": "920-929-9140",
            "fax_number": "920-929-9142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2009-06-22",
        "status": "A",
        "authorized_official_last_name": "COMERS",
        "authorized_official_first_name": "ROSONNA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-929-9140",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "29-036",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2270-057",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7003-123",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7209-123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "422-43800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; 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.