NPIMap

Organization Active NPI

GTN Fennimore, Inc.

Doing business as Southwest Counseling

  • Clinical Social Worker
  • Fennimore, WI
National Provider Identifier
1306251640
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
384 Issued in WI
Legal business name
GTN FENNIMORE, INC.
Doing business as
Southwest Counseling
Practice address
1160 Lincoln Ave
Fennimore, WI 53809-1746
Phone
(608) 822-5052
Fax
(608) 822-0131
NPI assigned
Jun 25, 2014
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Regina Ann Trollop, LCSW
Title
Owner
Phone
(608) 778-6978

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 384 WI Primary

Addresses

Primary practice location

1160 Lincoln Ave
Fennimore, WI 53809-1746

Mailing address

1160 Lincoln Ave
Fennimore, WI 53809-1746
Phone (608) 822-5052

Other identifiers 1

IdentifierTypeStateIssuer
39613700MedicaidWI

Other names 1

  • Southwest Counseling Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140701000695 WI Part B Supplier - Clinic/Group Practice 3072738335 Receives reassigned benefits from 5 practitioners
Practice locations: Fennimore, WI

National Provider Directory

National Provider Directory

Locations

1160 Lincoln Ave
Fennimore, WI 53809
Phone (608) 822-5052

770 Lincoln Ave
#7
Fennimore, WI 53809

770 Lincoln Ave
Ste 4
Fennimore, WI 53809
Phone (608) 822-5052

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1306251640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 LINCOLN AVE",
            "city": "FENNIMORE",
            "state": "WI",
            "postal_code": "538091746",
            "telephone_number": "608-822-5052",
            "fax_number": "608-822-0131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 LINCOLN AVE",
            "city": "FENNIMORE",
            "state": "WI",
            "postal_code": "538091746",
            "telephone_number": "608-822-5052",
            "fax_number": "608-822-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GTN FENNIMORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-25",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "TROLLOP",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-778-6978",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39613700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Counseling",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fennimore, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.