NPIMap

Organization Active NPI

Associated Counseling and Recovery Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fond Du Lac, WI
National Provider Identifier
1487712519
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
2060 Issued in WI
Legal business name
ASSOCIATED COUNSELING AND RECOVERY CENTER LLC
Practice address
551 W Johnson St
Fond Du Lac, WI 54935
Phone
(920) 907-0097
Fax
(920) 907-0109
NPI assigned
Dec 4, 2006
Last updated
Nov 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2010

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

Authorized official

Name
Mrs. Judith A Pollard, MSW LCSWNPI 1649346438
Title
Clinic Director
Phone
(920) 907-0097

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 2060 WI Primary

Addresses

Primary practice location

551 W Johnson St
Fond Du Lac, WI 54935

Mailing address

551 W Johnson St
Fond Du Lac, WI 54935
Phone (920) 907-0097

Other identifiers 1

IdentifierTypeStateIssuer
42209700MedicaidWI

National Provider Directory

National Provider Directory

Locations

551 W Johnson St
Fond du Lac, WI 54935
Phone (920) 390-4451

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290988800000",
    "number": "1487712519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 W JOHNSON ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "54935",
            "telephone_number": "920-907-0097",
            "fax_number": "920-907-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 W JOHNSON ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "54935",
            "telephone_number": "920-907-0097",
            "fax_number": "920-907-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED COUNSELING AND RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2010-11-29",
        "status": "A",
        "authorized_official_last_name": "POLLARD",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "920-907-0097",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "2060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42209700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; 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.