Individual provider Active NPI

Richard William Meyer II, LPC-IT

  • Professional Counselor
  • Green Bay, WI
National Provider Identifier
1417719774
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
7273-226 Issued in WI
Practice address
480 Pilgrim Way # 1300a
Green Bay, WI 54304-5280
Phone
(920) 610-5119
NPI assigned
Jan 23, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 7273-226 WI Primary

Addresses

Primary practice location

480 Pilgrim Way # 1300a
Green Bay, WI 54304-5280

Mailing address

480 Pilgrim Way # 1300a
Green Bay, WI 54304-5280

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250226003778 WI Practitioner - Mental Health Counselor 3476073990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

480 Pilgrim Way
1300 A
Green Bay, WI 54304-5280
Phone (920) 610-5119

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7273-226WIMDProfessional Counselor
11566WIMDMusic Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates Counseling Wi., S.C. CurrentSince Feb 6, 2025 Accepting new patients
Nystrom & Associates Counseling Wi., S.C. CurrentSince Feb 6, 2025 Accepting new patients

Locations

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

480 Pilgrim Way
#1300A
Green Bay, WI 54304
Phone (920) 610-5119

480 Pilgrim Way
Ste 1300A
Green Bay, WI 54304
Phone (920) 610-5119

201 Main St
Ste 500
La Crosse, WI 54601
Phone (608) 668-4005

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1705968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1417719774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 PILGRIM WAY # 1300A",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 PILGRIM WAY # 1300A",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045280",
            "telephone_number": "920-610-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEYER",
        "first_name": "RICHARD",
        "middle_name": "WILLIAM",
        "name_suffix": "II",
        "credential": "LPC-IT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7273-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.