Jacobs Well Presbyterian Churcha

Primary specialty

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

Legal business name

JACOBS WELL PRESBYTERIAN CHURCHA

Doing business as

Jacobs Well Church Counseling

Practice address

3340 Lineville Rd
Green Bay, WI 54313-7237

Phone

(920) 264-9564

NPI assigned

May 11, 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, LPCNPI 1760099329

Title

Pastor of Care and Counseling

Phone

(309) 532-2364

Specialties & licenses 1

Addresses

Other names 1

• Jacobs Well Church Counseling Doing business as

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": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1164006573",
    "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": "JACOBS WELL PRESBYTERIAN CHURCHA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "REA HANSEN",
        "authorized_official_title_or_position": "PASTOR OF CARE AND COUNSELING",
        "authorized_official_telephone_number": "309-532-2364",
        "authorized_official_credential": "LPC"
    },
    "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": [
        {
            "organization_name": "Jacobs Well Church Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shawn E Jackson, P.T.
• Andrew Jacob, DDS
• Jacob's Well Counseling Center Inc
• Jacob's Well Presbyterian Church
• Colleen Jacobe, RN
• Emily Laura Jacobson
• Martin A Jacobson, DC
• Katie Jacoby McCracken, CAPSW, SAC-IT
• Susan M Jacquez-Dean, M.D
• Deanne Jadin, PTA

• 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 May 11, 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.