NPIMap

Organization Active NPI

Trivium LLC

Doing business as Crossroads Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Janesville, WI
National Provider Identifier
1265450753
Registry record updated Dec 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
1265 Issued in WI
Legal business name
TRIVIUM LLC
Doing business as
Crossroads Counseling Center
Practice address
17 S. River St.
Suite 254
Janesville, WI 53548-3863
Phone
(608) 755-5260
Fax
(608) 755-5267
NPI assigned
Jul 17, 2006
Last updated
Dec 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2014

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

Authorized official

Name
Mr. Timothy F. Perry, MSSW, LCSW, LMFTNPI 1932137791
Title
Administrator
Phone
(608) 755-5260

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1265 WI Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 1265 WI
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2868 WI

Addresses

Primary practice location

17 S. River St.
Suite 254
Janesville, WI 53548-3863

Mailing address

17 S. River St
Suite 254
Janesville, WI 53548-3863
Phone (608) 755-5260

Other identifiers 1

IdentifierTypeStateIssuer
42105900MedicaidWI

Other names 1

  • Crossroads Counseling Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150428001780 WI Part B Supplier - Clinic/Group Practice 6800115676 Receives reassigned benefits from 15 practitioners
Practice locations: Janesville, WI

National Provider Directory

National Provider Directory

Locations

17 S River St
Ste 254
Janesville, WI 53548
Phone (608) 755-5260

722 Lois Dr
Sun Prairie, WI 53590
Phone (608) 755-5260

Practitioners & affiliated clinicians

Practitioners 84

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 84

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418256000000",
    "number": "1265450753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 S. RIVER ST",
            "address_2": "SUITE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483863",
            "telephone_number": "608-755-5260",
            "fax_number": "608-755-5267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 S. RIVER ST.",
            "address_2": "SUITE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483863",
            "telephone_number": "608-755-5260",
            "fax_number": "608-755-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIVIUM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2014-12-11",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "608-755-5260",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSSW, LCSW, LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "1265",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "1265",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "2868",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42105900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; 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.