Individual provider Active NPI

Michelle Lassa, LPC

  • Professional Counselor
  • Wausau, WI
National Provider Identifier
1487890398
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6309-125 Issued in WI
Practice address
630 S 36TH Ave
Wausau, WI 54401-3930
Phone
(715) 842-9500
NPI assigned
Dec 23, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6309-125 WI Primary

Addresses

Primary practice location

630 S 36TH Ave
Wausau, WI 54401-3930

Mailing address

630 S 36TH Ave
Wausau, WI 54401-3930

Other practice location 1

1100 Lake View Dr
Wausau, WI 54403-6785
Phone (715) 848-4600

Other names 1

  • Michelle A Jensen Former 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
I20240720000029 WI Practitioner - Mental Health Counselor 9234675737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Behavioral Health Clinic LLCGroup PAC ID 8628409885, 43 clinicians

Practice addresses (Care Compare)

630 S 36TH Ave
Wausau, WI 54401-3930
Phone (715) 842-9500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Health Clinic, LLC Professional CurrentSince Jun 18, 2024 Accepting new patients

Locations

2417 Post Rd
Stevens Point, WI 54481
Phone (715) 544-6144

630 S 36th Ave
Wausau, WI 54401
Phone (414) 301-1060

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1487890398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 S 36TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 S 36TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013930",
            "telephone_number": "715-842-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Lake View Dr",
            "address_purpose": "LOCATION",
            "city": "Wausau",
            "state": "WI",
            "postal_code": "544036785",
            "country_code": "US",
            "telephone_number": "715-848-4600",
            "fax_number": "715-845-5398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LASSA",
        "first_name": "MICHELLE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "6309-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "JENSEN",
            "middle_name": "A",
            "credential": "LPC-IT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.