Active NPI
Deborah H Black, LPC
- Professional Counselor
- Milwaukee, WI
National Provider Identifier
1366803389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5539-125
- Practice address
- 930 W Historic Mitchell St
Milwaukee, WI 53204-3533 - Phone
- (414) 383-9526
- Fax
- (414) 389-3881
- NPI assigned
- Mar 18, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5539-125 | WI | Primary |
Addresses
Primary practice location
930 W Historic Mitchell St
Milwaukee, WI 53204-3533
Mailing address
930 W Historic Mitchell St
Milwaukee, WI 53204-3533
Phone (414) 383-9526
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 391958089 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5539-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458259200000",
"number": "1366803389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 W HISTORIC MITCHELL ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532043533",
"telephone_number": "414-383-9526",
"fax_number": "414-389-3881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 W HISTORIC MITCHELL ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532043533",
"telephone_number": "414-383-9526",
"fax_number": "414-389-3881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "DEBORAH",
"middle_name": "H",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-18",
"last_updated": "2016-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "5539-125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "391958089",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.