Jacob'S Well Presbyterian Church

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JACOB'S WELL PRESBYTERIAN CHURCH

Practice address

3340 Lineville Rd
Green Bay, WI 54313-7237

Phone

(920) 264-9564

NPI assigned

Sep 14, 2021

Organization subpart

No

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

Authorized official

Name

Spencer Rea Hansen Thomas, LPC, NCCNPI 1760099329

Title

Executive Director

Phone

(309) 532-2364

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Spencer Rea Hansen Thomas, LPC

  • Professional Counselor
  • Green Bay, WI
  • NPI 1760099329
  NPD Authorized official

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1124798970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 LINEVILLE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137237",
            "telephone_number": "920-264-9564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 LINEVILLE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137237",
            "telephone_number": "920-264-9564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB'S WELL PRESBYTERIAN CHURCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "REA HANSEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "309-532-2364",
        "authorized_official_credential": "LPC, NCC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorraine Helena Mary Jackson, MD
• Peter Allen Jackson, PHARMD
• Shawn E Jackson, P.T.
• Andrew Jacob, DDS
• Jacob'S Well Counseling Center Inc
• Colleen Jacobe, RN
• Jacobs Well Presbyterian Churcha
• Emily Laura Jacobson
• Martin A Jacobson, DC
• Katie Jacoby McCracken, CAPSW, SAC-IT

• Mental Health Clinic/Center (Including Community Mental Health Center) in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.