NPIMap

Organization Active NPI

Ecumenical Health Center

Doing business as Autism Resources & Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
National Provider Identifier
1396936175
Registry record updated Aug 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
970057 Issued in WI
Legal business name
ECUMENICAL HEALTH CENTER
Doing business as
Autism Resources & Services
Practice address
1540 Capitol Dr
Suite 104
Green Bay, WI 54303-2235
Phone
(920) 491-9800
Fax
(920) 491-9800
NPI assigned
Aug 6, 2007
Last updated
Aug 6, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2007

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

Authorized official

Name
Mr. James Paul Heider, ED.S.NPI 1477743862
Title
Licensed Psychologist
Phone
(920) 491-9800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 104124 WI
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 970057 WI Primary
Counseling Psychologist 103TC1900X 970057 WI
Community/Behavioral Health Agency 251S00000X 104124 WI

Addresses

Primary practice location

1540 Capitol Dr
Suite 104
Green Bay, WI 54303-2235

Mailing address

1540 Capitol Dr
Suite 104
Green Bay, WI 54303-2235
Phone (920) 491-9800

Other identifiers 1

IdentifierTypeStateIssuer
39081000MedicaidWI

Other names 1

  • Autism Resources & Services Doing business as

National Provider Directory

National Provider Directory

Locations

1540 Capitol Dr
Ste 104
Green Bay, WI 54303
Phone (920) 491-9800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186358400000",
    "number": "1396936175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 CAPITOL DR",
            "address_2": "SUITE 104",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032235",
            "telephone_number": "920-491-9800",
            "fax_number": "920-491-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 CAPITOL DR",
            "address_2": "SUITE 104",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032235",
            "telephone_number": "920-491-9800",
            "fax_number": "920-491-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECUMENICAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2007-08-06",
        "status": "A",
        "authorized_official_last_name": "HEIDER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "920-491-9800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ED.S."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "104124",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "970057",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "WI",
            "license": "970057",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "104124",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39081000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autism Resources & Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.