Full Potential Coaching Counseling Consulting of Wi, LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

14034 Issued in WI

Legal business name

FULL POTENTIAL COACHING COUNSELING CONSULTING OF WI, LLC

Practice address

4710 E Broadway
Suite 135
Madison, WI 53716-4103

Phone

(608) 205-2294

Fax

(608) 719-5033

NPI assigned

Feb 22, 2017

Organization subpart

No

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

Authorized official

Name

Ted Izydor, MS, LPC, CSAC

Title

Owner

Phone

(608) 205-2294

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1487721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1528507605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4710 E BROADWAY",
            "address_2": "SUITE 135",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537164103",
            "telephone_number": "608-205-2294",
            "fax_number": "608-719-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 E BROADWAY",
            "address_2": "SUITE 135",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537164103",
            "telephone_number": "608-205-2294",
            "fax_number": "608-719-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL POTENTIAL COACHING COUNSELING CONSULTING OF WI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-22",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "IZYDOR",
        "authorized_official_first_name": "TED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-205-2294",
        "authorized_official_credential": "MS, LPC, CSAC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "14034",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "2878",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2017; 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.