NPIMap

Organization Active NPI

Meraki Therapy & Wellness, LLC

  • Counselor
  • Green Bay, WI
National Provider Identifier
1407593619
Registry record updated Nov 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
MERAKI THERAPY & WELLNESS, LLC
Practice address
1270 Main St Ste 120
Green Bay, WI 54302-1337
Phone
(920) 378-3575
NPI assigned
May 18, 2022
Last updated
Nov 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2022

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

Authorized official

Name
Michelle Waack, MAC, LPC, CSACNPI 1336784545
Title
Co-Owner
Phone
(920) 288-2846

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X

Addresses

Primary practice location

1270 Main St Ste 120
Green Bay, WI 54302-1337

Mailing address

1270 Main St Ste 120
Green Bay, WI 54302-1337
Phone (920) 288-2846

Other identifiers 2

IdentifierTypeStateIssuer
100095134MedicaidWI
1336784545MedicaidWI

National Provider Directory

National Provider Directory

Locations

1270 Main St
Ste 120
Green Bay, WI 54302
Phone (920) 288-2846

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": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668297600000",
    "number": "1407593619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 MAIN ST STE 120",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543021337",
            "telephone_number": "920-288-2846",
            "fax_number": "920-770-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 MAIN ST STE 120",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543021337",
            "telephone_number": "920-378-3575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERAKI THERAPY & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2022-11-13",
        "certification_date": "2022-11-13",
        "status": "A",
        "authorized_official_last_name": "WAACK",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "920-288-2846",
        "authorized_official_credential": "MAC, LPC, CSAC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100095134",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336784545",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Nov 13, 2022; 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.