Amy J Nissen, CADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

20087 Issued in IA

Practice address

1820 Central Ave
Estherville, IA 51334-2409

Phone

(800) 592-0180

Fax

(712) 566-5229

NPI assigned

Apr 26, 2022

Last updated

Apr 26, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Champion State of Mind PLLC

  • Mental Health Counselor
  • Estherville, IA
  • NPI 1033578331

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650931200000",
    "number": "1255075172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513340036",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 CENTRAL AVE",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513342409",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "703 16th St",
            "address_purpose": "LOCATION",
            "city": "Spirit Lake",
            "state": "IA",
            "postal_code": "513601623",
            "country_code": "US",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1430 1st Ave S",
            "address_purpose": "LOCATION",
            "city": "Estherville",
            "state": "IA",
            "postal_code": "513342402",
            "country_code": "US",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1520 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Estherville",
            "state": "IA",
            "postal_code": "513342450",
            "country_code": "US",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 S 17th St",
            "address_purpose": "LOCATION",
            "city": "Estherville",
            "state": "IA",
            "postal_code": "513342400",
            "country_code": "US",
            "telephone_number": "800-592-0180",
            "fax_number": "712-566-5229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NISSEN",
        "first_name": "AMY",
        "middle_name": "J",
        "credential": "CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-26",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IA",
            "license": "20087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Sarrett Meyer, D.D.S.
• Nicole Marie Miller, D.C.
• Moreau Chiropractic Clinic
• Moxie Nova
• Bridgit Elise Neider, PTA
• Kyle Norris
• Northwest Iowa Counseling Associates PC
• Northwest Iowa Podiatry
• Rebecca Nosbusch, MSW, LICSW
• Amanda Olson, LMHC

• Addiction (Substance Use Disorder) Counselor in Estherville, IA
• Providers in Estherville, IA by specialty
• Addiction (Substance Use Disorder) Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.