Active NPI
Paul Francis Theyel, CICSW
- Mental Health Counselor
- Wautoma, WI
National Provider Identifier
1154429462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1255
- Practice address
- 230 Park St
Wautoma, WI 54982-9031 - Phone
- (920) 787-6550
- Fax
- (920) 787-0421
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1255 | WI | Primary |
Addresses
Primary practice location
230 Park St
Wautoma, WI 54982-9031
Mailing address
230 Park St
PO Box 1230
Wautoma, WI 54982-9031
Phone (920) 787-6550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39624100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1255 | WI | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1154429462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 PARK ST",
"address_2": "PO BOX 1230",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "549829031",
"telephone_number": "920-787-6550",
"fax_number": "920-787-0421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 PARK ST",
"city": "WAUTOMA",
"state": "WI",
"postal_code": "549829031",
"telephone_number": "920-787-6550",
"fax_number": "920-787-0421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEYEL",
"first_name": "PAUL",
"middle_name": "FRANCIS",
"name_prefix": "Mr.",
"credential": "CICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "1255",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39624100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wautoma, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.