Active NPI
Susan Ellis, LPC
- Mental Health Counselor
- Germantown, WI
National Provider Identifier
1285247114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- W175N11163 Stonewood Dr Ste 106
Germantown, WI 53022-6501 - Phone
- (262) 345-4270
- NPI assigned
- Aug 29, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
W175N11163 Stonewood Dr Ste 106
Germantown, WI 53022-6501
Mailing address
W175N11163 Stonewood Dr Ste 106
Germantown, WI 53022-6501
Phone (262) 345-4270
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 2, 2024 through Jan 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675123200000",
"number": "1285247114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W175N11163 STONEWOOD DR STE 106",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "530226501",
"telephone_number": "262-345-4270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W175N11163 STONEWOOD DR STE 106",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "530226501",
"telephone_number": "262-345-4270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "SUSAN",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-29",
"last_updated": "2023-01-31",
"certification_date": "2023-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.