Active NPI
Beth Ann Burnside
- Addiction (Substance Use Disorder) Counselor
- Green Bay, WI
National Provider Identifier
1437614286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 16447
- Practice address
- 3150 Gershwin Dr
Green Bay, WI 54311-4328 - Phone
- (920) 391-4700
- Fax
- (920) 391-4731
- NPI assigned
- Feb 6, 2019
- Last updated
- Jul 27, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16447 | WI | Primary |
Addresses
Primary practice location
3150 Gershwin Dr
Green Bay, WI 54311-4328
Mailing address
374 S Peck Ave
Peshtigo, WI 54157-1511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16447 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627344000000",
"number": "1437614286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "374 S PECK AVE",
"city": "PESHTIGO",
"state": "WI",
"postal_code": "541571511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 GERSHWIN DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543114328",
"telephone_number": "920-391-4700",
"fax_number": "920-391-4731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURNSIDE",
"first_name": "BETH",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-06",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "16447",
"primary": true
}
],
"identifiers": [],
"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 Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.