NPIMap

Organization Active NPI

Northwest Counseling & Guidance Clinic

  • Adolescent and Children Mental Health Clinic/Center
  • Wausau, WI
National Provider Identifier
1275650350
Registry record updated Nov 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
NORTHWEST COUNSELING & GUIDANCE CLINIC
Practice address
5655 N. 28TH Ave
Wausau, WI 54401-9709
Phone
(715) 675-5454
Fax
(715) 675-0545
NPI assigned
Mar 23, 2007
Last updated
Nov 23, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST COUNSELING AND GUIDANCE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 23, 2015

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

Authorized official

Name
Jackie J Maurer
Title
Billing Office Supervisor
Phone
(715) 327-4322

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2404 WI
Adolescent and Children Mental Health Clinic/Center 261QM0855X WI Primary

Addresses

Primary practice location

5655 N. 28TH Ave
Wausau, WI 54401-9709

Mailing address

203 United Way
Frederic, WI 54837-8938
Phone (715) 327-4322

Other identifiers 4

IdentifierTypeStateIssuer
4300700MedicaidWI
85575OtherMNPREFERRED ONE
42626OtherMNHEALTH PARTNERS
43007000MedicaidWI

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

203 United Way
Frederic, WI 54837
Phone (715) 327-4322

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": "1448236800000",
    "number": "1275650350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 UNITED WAY",
            "city": "FREDERIC",
            "state": "WI",
            "postal_code": "548378938",
            "telephone_number": "715-327-4322",
            "fax_number": "715-327-8509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5655 N. 28TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544019709",
            "telephone_number": "715-675-5454",
            "fax_number": "715-675-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST COUNSELING & GUIDANCE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST COUNSELING AND GUIDANCE CLINIC",
        "enumeration_date": "2007-03-23",
        "last_updated": "2015-11-23",
        "status": "A",
        "authorized_official_last_name": "MAURER",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BILLING OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "715-327-4322"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "2404",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4300700",
            "state": "WI"
        },
        {
            "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": "43007000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; 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.