Beth Provost, LCSW, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

12062-123 Issued in WI

Practice address

1060A Lowell Dr
Oconomowoc, WI 53066-4337

Phone

(262) 443-7917

NPI assigned

Mar 23, 2016

Last updated

Dec 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wisconsin Lutheran Child and Family Service Inc

  dba Christian Family Solutions

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Germantown, WI
  • NPI 1083786628

  Clinical

  Medicare reassignment NPD
• Oak Tree Child and Family Services LLC

  • Mental Health Counselor
  • Fort Atkinson, WI
  • NPI 1588198774
  Medicare reassignment
• Wisconsin Lutheran Child & Family Service, Inc

  dba Christian Family Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Appleton, WI
  • NPI 1750475513

  Clinical

  NPD
• Richard Kneip, PH.D., P.C.

  dba Great Lakes Psychology Group

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  NPD (past)
• Wellqor Psychological Services, PC

  • Clinical Psychologist
  • Melville, NY
  • NPI 1063920841
  NPD (past)

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1194187757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E 11TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060A LOWELL DR",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664337",
            "telephone_number": "262-443-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "BETH",
        "credential": "LCSW, LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-23",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IA",
            "license": "115179",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "12062-123",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "11953-123",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prohealth Medical Group Inc
• Prohealth Medical Group Inc
• Prohealth Oconomowoc Memorial Hospital, Inc.
• Prohealth Oconomowoc Memorial Hospital, Inc. (ProHealth Pharmacy - Oconomowoc)
• Prohealth Oconomowoc Memorial Hospital, Inc.
• Purity Dialysis Centers, Inc (Oconomowoc Dialysis Center)
• Quad/Med, LLC
• Adam T. Quetsch, DDS
• Brian James Quick, LPC
• Radiology Consultants of Wisconsin

• Social Worker in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.