Sharayah K Provost, LPC

Key facts

NPI

1477025823

Entity type

Individual (NPI type 1)

Primary specialty

Professional Counselor 101YP2500X

License

7206-125 (WI)

Practice address

16535 W Bluemound Rd Ste 305
Brookfield, WI 53005-5936

Phone

(800) 438-1770

Fax

(262) 345-5562

NPI assigned

Dec 26, 2018

Sex

Female

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wisconsin Lutheran Child and Family Service Inc Mental Health Clinic/Center (Including Community Mental Health Center) · Germantown, WI · NPI 1083786628
  Medicare reassignment Care Compare group NPD PROFESSIONAL · WI
• Wisconsin Lutheran Child & Family Service Counseling Psychologist · Milwaukee, WI · NPI 1790202851
  NPD (past)
• Wisconsin Lutheran Child & Family Services, Inc Adolescent and Children Mental Health Clinic/Center · Brookfield, WI · NPI 1194961474
  NPD (past) PROFESSIONAL

Medicare Care Compare profile

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wisconsin Lutheran Child and Family Service Inc (35 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Sharayah K Honeyager Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 10, 2020.

{
    "created_epoch": "1545782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1477025823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W175N11120 STONEWOOD DR",
            "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": "16535 W BLUEMOUND RD STE 305",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530055936",
            "telephone_number": "800-438-1770",
            "fax_number": "262-345-5562"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2669 N Richards St",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532122850",
            "country_code": "US",
            "telephone_number": "800-438-1772",
            "fax_number": "262-345-5562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "SHARAYAH",
        "middle_name": "K",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-26",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3367-226",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "7206-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100084565",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHARAYAH",
            "last_name": "HONEYAGER",
            "middle_name": "K",
            "credential": "LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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