Active NPI
Mark W Juergens, LCSW LPC
- Professional Counselor
- Eau Claire, WI
National Provider Identifier
1376509588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1839125
- Practice address
- 4330 Golf Ter
Suite 214
Eau Claire, WI 54701-4683 - Phone
- (715) 833-2121
- Fax
- (715) 833-2131
- NPI assigned
- Apr 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 1839125 | WI | Primary |
Addresses
Primary practice location
4330 Golf Ter
Suite 214
Eau Claire, WI 54701-4683
Mailing address
4330 Golf Ter
Suite 214
Eau Claire, WI 54701-4683
Phone (715) 833-2121
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40986200 | Medicaid | WI | |
| 95846 | Other | WI | SECURITY HEALTH PLAN |
| 6250399 | Other | MN | MEDICA UBH UHC |
| HP52029 | Other | MN | HEALTH PARTNERS |
| 574 | Other | MN | BCBS MN |
Other names 1
- Mark W Juergens
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1839125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367971200000",
"number": "1376509588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4330 GOLF TER",
"address_2": "SUITE 214",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547014683",
"telephone_number": "715-833-2121",
"fax_number": "715-833-2131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4330 GOLF TER",
"address_2": "SUITE 214",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547014683",
"telephone_number": "715-833-2121",
"fax_number": "715-833-2131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUERGENS",
"first_name": "MARK",
"middle_name": "W",
"credential": "LCSW LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2013-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "1839125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40986200",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECURITY HEALTH PLAN",
"identifier": "95846",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA UBH UHC",
"identifier": "6250399",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP52029",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MN",
"identifier": "574",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARK",
"last_name": "JUERGENS",
"middle_name": "W",
"credential": "LCSW",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Eau Claire, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.