Clint Starks, SACIT, LPCIT
Individual provider Active NPI Professional Counselor · Montello, WI
NPI 1437415486 · NPPES record last updated Mar 16, 2016
Key facts
- NPI
- 1437415486
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 1577-226 (WI)
- Practice address
- 480 Underwood Ave
Montello, WI 53949-9248 - Phone
- (608) 297-3181
- Fax
- (608) 297-2148
- NPI assigned
- Apr 4, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16564130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 1577-226 | WI | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16564130 | WI | |
| Professional Counselor | 101YP2500X | 1577-226 | WI | Yes |
Addresses
Primary practice location
480 Underwood Ave
Montello, WI 53949-9248
Mailing address
480 Underwood Ave
Montello, WI 53949-9248
Phone (608) 297-3181
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- Jody Ann Triggs
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All providers in Montello, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.