NPIMap

Organization Active NPI

Cedar Creek Counseling, S.C.

  • Counseling Psychologist
  • Mequon, WI
National Provider Identifier
1134355308
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
057-2140 Issued in WI
Legal business name
CEDAR CREEK COUNSELING, S.C.
Practice address
1035 W Glen Oaks LN
Suite 110
Mequon, WI 53092-3392
Phone
(262) 240-0299
Fax
(262) 240-0308
NPI assigned
Jun 2, 2009
Last updated
Sep 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2015

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

Authorized official

Name
Dr. Byron C Bloemer, PH.D.NPI 1316081698
Title
Psychologist
Phone
(262) 240-0299

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 057-2140 WI Primary

Addresses

Primary practice location

1035 W Glen Oaks LN
Suite 110
Mequon, WI 53092-3392

Mailing address

1035 W Glen Oaks LN
Suite 110
Mequon, WI 53092-3392
Phone (262) 240-0299

National Provider Directory

National Provider Directory

Locations

1035 W Glen Oaks Ln
Ste 110
Mequon, WI 53092
Phone (262) 240-0299

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1134355308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 W GLEN OAKS LN",
            "address_2": "SUITE 110",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923392",
            "telephone_number": "262-240-0299",
            "fax_number": "262-240-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 W GLEN OAKS LN",
            "address_2": "SUITE 110",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923392",
            "telephone_number": "262-240-0299",
            "fax_number": "262-240-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK COUNSELING, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-02",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "BLOEMER",
        "authorized_official_first_name": "BYRON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "262-240-0299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "WI",
            "license": "057-2140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; 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.