NPIMap

Organization Active NPI

Affiliated Counseling Center, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beaver Dam, WI
National Provider Identifier
1164568879
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 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
Last updated
Jun 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Authorized official

Name
Mr. Daniel Massie, LCSWNPI 1427355445
Title
Authorized Official
Phone
(920) 887-8751

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

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 1

IdentifierTypeStateIssuer
42187100MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040419001617 WI Part B Supplier - Clinic/Group Practice 5991790883 Receives reassigned benefits from 2 practitioners
Practice locations: Beaver Dam, WI

National Provider Directory

National Provider Directory

Locations

1807 N Center St
Ste 204
Beaver Dam, WI 53916
Phone (920) 887-8751

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1164568879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 N CENTER ST STE 204",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539161005",
            "telephone_number": "920-887-8751",
            "fax_number": "920-887-3977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 N CENTER ST STE 204",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539161005",
            "telephone_number": "920-887-8751",
            "fax_number": "920-887-3977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFILIATED COUNSELING CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "MASSIE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "920-887-8751",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42187100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.