Perry J Anderson Jr., MSW
Individual provider Active NPI Mental Health Counselor · Balsam Lake, WI
NPI 1457574527 · NPPES record last updated Aug 2, 2010
Key facts
- NPI
- 1457574527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 6798-123 (WI)
- Practice address
- 100 Polk County PLZ
Suite 50
Balsam Lake, WI 54810-9071 - Phone
- (715) 485-8445
- Fax
- (715) 485-8490
- NPI assigned
- Apr 10, 2007
- 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)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6798-123 | WI | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6798-123 | WI | Yes |
Addresses
Primary practice location
100 Polk County PLZ
Suite 50
Balsam Lake, WI 54810-9071
Mailing address
440 105TH St
Amery, WI 54001-4010
Phone (715) 268-5165
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40930200 | Medicaid | WI | |
| 1258073 | Other | WI | ARAZ INSURANCE |
| 2068111 | Other | WI | CIGNA INSURANCE |
| 338871 | Other | WI | TRI CARE INSURANCE |
| P 12027501 | Other | WI | WPPN INSURANCE |
| 84 81085 | Other | WI | MEDICA INSURANCE |
| 373595 | Other | WI | MHN HMC INSURANCE |
| 37F39PE | Other | WI | BCBS MN INSURANCE |
| 1026794 | Other | WI | PREFERRED ONE INSURANCE |
Other providers in Balsam Lake, WI
- Craig R Anderson
- William J P Anderson
- Kalli Bittner
- Kristin M Boland
- Heather Christine Bonetti
- Norma J Buck
All providers in Balsam Lake, WI · Mental Health 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 Aug 2, 2010. 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.