Affiliated Counseling Center, Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Beaver Dam, WI
NPI 1164568879 · NPPES record last updated Jun 26, 2025
Key facts
- NPI
- 1164568879
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- AFFILIATED COUNSELING CENTER, INC
- Practice address
- 1807 N Center St Ste 204
Beaver Dam, WI 53916-1005 - Phone
- (920) 887-8751
- Fax
- (920) 887-3977
- NPI assigned
- Jan 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Daniel Massie, LCSW
- Title
- Authorized Official
- Phone
- (920) 887-8751
Practitioners 22
-
Robert Frank, APNP
-
Daniel Joseph Massie, LCSW, CSAC, CS-IT
-
Lisa Lee Derr, LPC-IT
-
Prabhu Venkataraman, LPC-IT
-
Richard J Bronecki, LISW, CEAP, SAP
-
Debra Lynn Conway, MS LPC
-
Jeffrey L Garbelman, PHD
-
Ben Nmi Green, PHD
-
Tricia M Hechimovich, MSW
-
Brooke T Kysely, MS, LPC, NCC
-
Linda Nauth, M.S.
-
Carol Roddy, CSAC
-
Karla F Willis, MS, LPC
-
Raymond Michael Wood, PHD
-
Richard Zabriskie, MSW, LCSW, CADC
-
Sanjay Agarwal, M.D.
-
Katelyn Mae Grant, MS, LPC, NCC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040419001617 | WI | Part B Supplier - Clinic/Group Practice | 5991790883 |
Receives reassigned benefits from 2 practitioners Practice locations: Beaver Dam, WI |
National Provider Directory
Locations
1807 N Center St
Ste 204
Beaver Dam, WI 53916
Phone (920) 887-8751
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
1807 N Center St Ste 204
Beaver Dam, WI 53916-1005
Mailing address
1807 N Center St Ste 204
Beaver Dam, WI 53916-1005
Phone (920) 887-8751
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42187100 | Medicaid | WI |
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All providers in Beaver Dam, WI · Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.