NPIMap

Organization Active NPI

Northwest Counseling & Guidance Clinic

Doing business as Northwest Journey-DePere

  • Adolescent and Children Mental Health Clinic/Center
  • Kimberly, WI
National Provider Identifier
1225155393
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
2160 Issued in WI
Legal business name
NORTHWEST COUNSELING & GUIDANCE CLINIC
Doing business as
Northwest Journey-DePere
Practice address
1119 W Kennedy Ave
Ste a
Kimberly, WI 54136-2213
Phone
(920) 364-9668
Fax
(888) 625-8634
NPI assigned
Mar 23, 2007
Last updated
Aug 15, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST COUNSELING & GUIDANCE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Authorized official

Name
Jackie J Maurer
Title
Office Supervisor
Phone
(715) 349-7069

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2160 WI Primary

Addresses

Primary practice location

1119 W Kennedy Ave
Ste a
Kimberly, WI 54136-2213

Mailing address

PO Box 309
Siren, WI 54872-0309
Phone (715) 349-7069

Other identifiers 3

IdentifierTypeStateIssuer
85575OtherMNPREFERRED ONE
42626OtherMNHEALTH PARTNERS
43005000MedicaidWI

Other names 1

  • Northwest Journey-DePere Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northwest CNSL Guid22 organizations share this tax ID, including this one
Part of
Northwest CNSL Guid

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

442 N Westhill Blvd
Ste B
Appleton, WI 54914
Phone (920) 364-9668

300 S 6th St
De Pere, WI 54115
Phone (920) 336-8950

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": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1225155393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 309",
            "city": "SIREN",
            "state": "WI",
            "postal_code": "548720309",
            "telephone_number": "715-349-7069",
            "fax_number": "888-625-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 W KENNEDY AVE",
            "address_2": "STE A",
            "city": "KIMBERLY",
            "state": "WI",
            "postal_code": "541362213",
            "telephone_number": "920-364-9668",
            "fax_number": "888-625-8634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST COUNSELING & GUIDANCE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST COUNSELING & GUIDANCE CLINIC",
        "enumeration_date": "2007-03-23",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "MAURER",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "715-349-7069"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "2160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "85575",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "42626",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43005000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Journey-DePere",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kimberly, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; 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.