NPIMap

Organization Active NPI

Professional Services Group, Inc.

  • Mental Health Counselor
  • Racine, WI
National Provider Identifier
1124104740
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
2657 Issued in WI
Legal business name
PROFESSIONAL SERVICES GROUP, INC.
Practice address
800 Goold St
Racine, WI 53402-4567
Phone
(262) 638-2000
Fax
(262) 638-2006
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

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

Authorized official

Name
Dr. Brian A. Wolf, PHD
Title
Clinical Director
Phone
(262) 652-2406

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 2657 WI
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 2657 WI Primary

Addresses

Primary practice location

800 Goold St
Racine, WI 53402-4567

Mailing address

6233 39TH Ave
Kenosha, WI 53142-7015
Phone (262) 654-1004

Other identifiers 1

IdentifierTypeStateIssuer
42246800MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Professional Services Group Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6233 39th Ave
Kenosha, WI 53142
Phone (262) 654-1004

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1124104740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6233 39TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427015",
            "telephone_number": "262-654-1004",
            "fax_number": "262-654-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 GOOLD ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534024567",
            "telephone_number": "262-638-2000",
            "fax_number": "262-638-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL SERVICES GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "262-652-2406",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "2657",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "2657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42246800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.