Brock Conrad Klement, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

10038-125 Issued in WI

Practice address

2501 Hanley Rd Ste 201
Hudson, WI 54016-8786

Phone

(534) 544-5247

Fax

(534) 544-5248

NPI assigned

Nov 3, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mr. Brock Klement Ham Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nystrom and Associates Counseling Wi SCGroup PAC ID 1052729464, 108 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nystrom & Associates Counseling Wi., S.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • La Crosse, WI
  • NPI 1659977866
  Medicare reassignment Care Compare group NPD
• Nystrom & Associates Counseling Wi., S.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1104549047
  NPD

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

{
    "created_epoch": "1635897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1366107484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 13TH ST S APT 221",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540162157",
            "telephone_number": "928-814-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 HANLEY RD STE 201",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540168786",
            "telephone_number": "534-544-5247",
            "fax_number": "534-544-5248"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6524 W Whispering Wind Dr",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853103458",
            "country_code": "US",
            "telephone_number": "928-814-3279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KLEMENT",
        "first_name": "BROCK",
        "middle_name": "CONRAD",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-03",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LPC-18611",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "2751",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "10038-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROCK",
            "last_name": "HAM",
            "middle_name": "KLEMENT",
            "prefix": "MR.",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kacey King, MS, MFT-IT
• Michelle Nicole King
• Sheryl King, M.A., M.ED., MFT
• Jordan N Kinstner, PA-C
• Lauren Linnea Alexander Kishawy, RDN
• Darla Klementz, PHARM D.
• Marvin D Klingler, M.D.
• Tom Olaf Kloster, DDS
• Lauren Elise Knapp, PA-C
• Andrea Christina Knievel, M.D.

• Professional Counselor in Hudson, WI
• Providers in Hudson, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.