Coram Consulting LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2862-57 Issued in WI

Legal business name

CORAM CONSULTING LLC

Practice address

431 S Main St Ste 6
Rice Lake, WI 54868-2241

Phone

(715) 931-0317

NPI assigned

Feb 2, 2017

Organization subpart

No

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

Authorized official

Name

Amber G Ebert, PSYD

Title

Licensed Psychologist

Phone

(715) 931-0317

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1485993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690329600000",
    "number": "1427596121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 N 2ND ST STE C",
            "city": "CAMERON",
            "state": "WI",
            "postal_code": "548227736",
            "telephone_number": "715-931-0317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 S MAIN ST STE 6",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548682241",
            "telephone_number": "715-931-0317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAM CONSULTING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-02",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A",
        "authorized_official_last_name": "EBERT",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "715-931-0317",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "2862-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2023; 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.