Northeast Wisconsin Behavioral Health SC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

NORTHEAST WISCONSIN BEHAVIORAL HEALTH SC

Practice address

529 South Jefferson Street
Suite 202
Green Bay, WI 54301-4125

Phone

(920) 884-2175

Fax

(920) 884-6735

NPI assigned

Jul 24, 2007

Organization subpart

No

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

Authorized official

Name

Suzette Marie Kosnar-Tittl, LICSW

Title

Owner, Ceo, Provider

Phone

(920) 884-2175

Specialties & licenses 5

Addresses

Other identifiers 8

Locations

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1275733602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 SOUTH JEFFERSON STREET",
            "address_2": "SUITE 202",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014125",
            "telephone_number": "920-884-2175",
            "fax_number": "920-884-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 SOUTH JEFFERSON STREET",
            "address_2": "SUITE 202",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014125",
            "telephone_number": "920-884-2175",
            "fax_number": "920-884-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST WISCONSIN BEHAVIORAL HEALTH SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "KOSNAR-TITTL",
        "authorized_official_first_name": "SUZETTE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER, CEO, PROVIDER",
        "authorized_official_telephone_number": "920-884-2175",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "4044-123",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "2376 125",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "4044 123",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "489 124",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER MEDICAID #",
            "identifier": "39722900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINICMEDICARE# GREENBAY",
            "identifier": "000044900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC NPI#",
            "identifier": "1275733602",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINICMEDICARE#OSHKOSH",
            "identifier": "000044905",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NPI",
            "identifier": "1285736249",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDERMEDICARE#GREENBAY",
            "identifier": "000144900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDERMEDICARE#OSHKOSH",
            "identifier": "000144905",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC MEDICAID #",
            "identifier": "4225100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Noldin, CRNA APNP
• Brittany A Nor, APNP
• Charles Nordell, MD
• Janna Nordeman, MSW, LCSW
• Norhteasr Wisconsin Personal Care
• Northeast Wisconsin Technical College
• Northwest Counseling & Guidance Clinic
• Northwoods Family Physical Medicine of Wisconsin, S.C.
• Susan Norton, MS LPC
• Althea L. Noukki, PH.D.

• Mental Health Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; 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.