Theresa A Douglas, MS., LPC-T

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

4539 Woodgate Dr Ste D
Janesville, WI 53546-8205

Phone

(818) 208-4774

NPI assigned

Oct 30, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Law, Master of Science

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.

• Your Genx Therapist LLC

  • Mental Health Counselor
  • Janesville, WI
  • NPI 1669211082

  Mental Health, WI

  Medicare reassignment NPD Authorized official
• Associates in Psychotherapy, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Janesville, WI
  • NPI 1831448091

  Professional, WI

  Medicare reassignment NPD
• Trivium LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Janesville, WI
  • NPI 1265450753
  NPD (past)
• Trivium LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Sun Prairie, WI
  • NPI 1427463066
  NPD (past)

Specialty

Mental Health Counselor

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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

{
    "created_epoch": "1383091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1376971226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4539 WOODGATE DR STE D",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535468205",
            "telephone_number": "818-208-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4539 WOODGATE DR STE D",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535468205",
            "telephone_number": "818-208-4774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "428 S Yellowstone Dr",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537191043",
            "country_code": "US",
            "telephone_number": "818-208-4774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "THERESA",
        "middle_name": "A",
        "credential": "MS., LPC-T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-30",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "5662-125",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tami R Dosch, LCSW
• Douglas & Mork Chiropractic S C
• Brigham Douglas, M.D.
• Allison Dowell
• Down to Earth Autism Care LLC
• John J Downing, MD
• Dr. Mark Boeche D.D.S. Inc.
• Tiffany J. Draeving, DPT

• All providers in Janesville, WI
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; 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.