Individual provider Active NPI

Sharayah K Provost, LPC

  • Professional Counselor
  • Brookfield, WI
National Provider Identifier
1477025823
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
7206-125 Issued in 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
Last updated
Feb 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 3367-226 WI
Professional Counselor 101YP2500X 7206-125 WI Primary

Addresses

Primary practice location

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

Mailing address

W175N11120 Stonewood Dr
Germantown, WI 53022-6511
Phone (800) 438-1772

Other practice location 1

2669 N Richards St
Milwaukee, WI 53212-2850
Phone (800) 438-1772

Other identifiers 1

IdentifierTypeStateIssuer
100084565MedicaidWI

Other names 1

  • Sharayah K Honeyager Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240125002009 WI Practitioner - Mental Health Counselor 3173976230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

W175N11056 Stonewood Dr
Germantown, WI 53022-4799
Phone (262) 345-5562

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3367-226WIMDProfessional Counselor
7206-125WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Wisconsin Lutheran Child and Family Service Inc Professional CurrentSince Jan 1, 2024 Accepting new patients
Wisconsin Lutheran Child & Family Services, Inc Professional PastSince Feb 16, 2020 Accepting new patients
Wisconsin Lutheran Child & Family Service Past Accepting new patients

Locations

16535 W Bluemound Rd
Ste 305
Brookfield, WI 53005
Phone (800) 438-1770

W175N11120 Stonewood Dr
Germantown, WI 53022
Phone (262) 345-5533

2669 N Richards St
Milwaukee, WI 53212

9555 S Howell Ave
Oak Creek, WI 53154
Phone (262) 345-5560

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "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"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.