Active NPI
Doug Ryan Pulvermacher, MS LPC
- Professional Counselor
- Milwaukee, WI
National Provider Identifier
1508065582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3427125
- Practice address
- 3903 W Lisbon Ave
Milwaukee, WI 53208 - Phone
- (414) 342-2060
- Fax
- (414) 342-3663
- NPI assigned
- Jul 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3427125 | WI | Primary |
Addresses
Primary practice location
3903 W Lisbon Ave
Milwaukee, WI 53208
Mailing address
1244 N 68TH Street
#207
Wauwatosa, WI 53213
Phone (414) 750-5261
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40952100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3427125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1508065582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1244 N 68TH STREET",
"address_2": "#207",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "53213",
"telephone_number": "414-750-5261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3903 W LISBON AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53208",
"telephone_number": "414-342-2060",
"fax_number": "414-342-3663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PULVERMACHER",
"first_name": "DOUG",
"middle_name": "RYAN",
"name_prefix": "Mr.",
"credential": "MS LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-11",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "3427125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40952100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.