NPIMap

Organization Active NPI

Counseling Associates of Door County, LLC

  • Counselor
  • Sturgeon Bay, WI
National Provider Identifier
1124093547
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
1250 Issued in WI
Legal business name
COUNSELING ASSOCIATES OF DOOR COUNTY, LLC
Practice address
620 N 12TH Ave
Sturgeon Bay, WI 54235-1249
Phone
(920) 743-9554
Fax
(920) 743-1591
NPI assigned
Feb 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
William G Nick, MSE, LCSW
Title
Clinic Owner
Phone
(920) 743-9554

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X 2924-125 WI
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X 1250 WI Primary
Clinic/Center 261Q00000X

Addresses

Primary practice location

620 N 12TH Ave
Sturgeon Bay, WI 54235-1249

Mailing address

PO Box 873
Sturgeon Bay, WI 54235-0873
Phone (920) 559-7482

Other identifiers 1

IdentifierTypeStateIssuer
42176400MedicaidWI

National Provider Directory

National Provider Directory

Locations

620 N 12th Ave
Sturgeon Bay, WI 54235
Phone (920) 743-9554

Practitioners & affiliated clinicians

Practitioners 6

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": "1140393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1124093547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 873",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542350873",
            "telephone_number": "920-559-7482",
            "fax_number": "920-743-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N 12TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351249",
            "telephone_number": "920-743-9554",
            "fax_number": "920-743-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNSELING ASSOCIATES OF DOOR COUNTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-20",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "NICK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CLINIC OWNER",
        "authorized_official_telephone_number": "920-743-9554",
        "authorized_official_credential": "MSE, LCSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "WI",
            "license": "2924-125",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "WI",
            "license": "1250",
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42176400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturgeon Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.