NPIMap

Organization Active NPI

Mend Counseling LLC

  • Professional Counselor
  • Appleton, WI
National Provider Identifier
1457087850
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MEND COUNSELING LLC
Practice address
1712 N Drew St
Appleton, WI 54911-2927
Phone
(920) 234-6842
NPI assigned
Jul 27, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

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

Authorized official

Name
Mr. Jonathon Donald Jacobs, MS, NCC, LPCNPI 1659750594
Title
Lead Clinician/Owner
Phone
(920) 234-6842

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

1712 N Drew St
Appleton, WI 54911-2927

Mailing address

1712 N Drew St
Appleton, WI 54911-2927
Phone (920) 234-6842

Other identifiers 1

IdentifierTypeStateIssuer
100058290MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241118002132 WI Part B Supplier - Clinic/Group Practice 0840724522 Receives reassigned benefits from 15 practitioners
Practice locations: Appleton, WI

National Provider Directory

National Provider Directory

Locations

1835 E Edgewood Dr
Ste 105107
Appleton, WI 54913
Phone (920) 234-6842

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1658880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666742400000",
    "number": "1457087850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 N DREW ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549112927",
            "telephone_number": "920-234-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 N DREW ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549112927",
            "telephone_number": "920-234-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEND COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-27",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "LEAD CLINICIAN/OWNER",
        "authorized_official_telephone_number": "920-234-6842",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, NCC, LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100058290",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.