Wisconsin Lutheran Child & Family Service

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH-11075 Issued in FL

Legal business name

WISCONSIN LUTHERAN CHILD & FAMILY SERVICE

Doing business as

Christian Family Counseling

Practice address

870 Hollywood Blvd
West Melbourne, FL 32904-7418

Phone

(800) 438-1772

Fax

(262) 293-9737

NPI assigned

Nov 1, 2016

Last updated

Nov 1, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Klug

Title

Ceo

Phone

(888) 685-9522

Specialties & licenses 1

Addresses

Other names 1

• Christian Family Counseling Doing business as

Tax ID family

Christian Family Counseling62 organizations share this tax ID, including this one

Locations

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.

• Jeremy De Wayne Long, LMHC, LPC

  • Professional Counselor
  • West Melbourne, FL
  • NPI 1831458561

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1447702956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W175N11120 STONEWOOD DR",
            "address_2": "ATTN: LINDA RANGEL",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226511",
            "telephone_number": "800-438-1772",
            "fax_number": "262-293-9737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 HOLLYWOOD BLVD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329047418",
            "telephone_number": "800-438-1772",
            "fax_number": "262-293-9737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN LUTHERAN CHILD & FAMILY SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-01",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "KLUG",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-685-9522"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH-11075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christian Family Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Marie Wilkinson, DPT
• William D. Tanke, OD, PA
• Ashley Nicole Williams, APRN, FNP-C
• Yanna Wills, APRN
• Samuel Winn, OD
• Jennifer Leah Woodall
• Steve Brent Wooten II
• Jade Wright
• Ashley Yeargin
• Richard Allen Young, PT

• Mental Health Counselor in West Melbourne, FL
• Providers in West Melbourne, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; 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.