Troy Harris, BS, SAC-IT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Sparta, WI
NPI 1356833495 · NPPES record last updated Feb 16, 2021
Key facts
- NPI
- 1356833495
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 16428-131 (WI)
- Practice address
- 618 Prairie Ave
Sparta, WI 54656-2534 - Phone
- (608) 633-8065
- NPI assigned
- Jun 5, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16428-131 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 18480-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 18480-130 | WI | |
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | 16428-131 | WI | Yes |
Addresses
Primary practice location
618 Prairie Ave
Sparta, WI 54656-2534
Mailing address
618 Prairie Ave
Sparta, WI 54656-2534
Phone (608) 633-8065
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003150004 | Medicaid | WI |
Other providers in Sparta, WI
- Matthew James Hansen
- Peter Hansen
- Ann C Hanson
- Erin E. Hardy
- Sandra Harper
- Hart Serenity Counseling, LLC
- Healing With Heart LLC
- Richard D Hensgen
- Rebecca Hope Horstman
- Leslie Marie Hove
All providers in Sparta, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.