NPIMap

Organization Active NPI

Stateline Mental Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beloit, WI
National Provider Identifier
1538560255
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
STATELINE MENTAL HEALTH SERVICES
Practice address
540 E Grand Ave
Beloit, WI 53511-6314
Phone
(608) 368-8087
NPI assigned
Sep 12, 2014
Last updated
Mar 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Authorized official

Name
Stephanie Knueppel, LPCNPI 1811177991
Title
Psychotherapist
Phone
(608) 217-7264

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

540 E Grand Ave
Beloit, WI 53511-6314

Mailing address

2745 Fawn CT
Beloit, WI 53511-1973

Other practice location 1

1411 Pate Plaza Dr
South Beloit, IL 61080-1431
Phone (608) 368-8087

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170308001000 WI Part B Supplier - Clinic/Group Practice 1658655865 Receives reassigned benefits from 32 practitioners
Practice locations: Beloit, WI

National Provider Directory

National Provider Directory

Locations

1411 Pate Plaza Dr
South Beloit, IL 61080
Phone (608) 368-8087

540 E Grand Ave
Beloit, WI 53511
Phone (608) 365-8575

Practitioners & affiliated clinicians

Practitioners 33

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.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1410480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1538560255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2745 FAWN CT",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535111973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E GRAND AVE",
            "city": "BELOIT",
            "state": "WI",
            "postal_code": "535116314",
            "telephone_number": "608-368-8087"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 Pate Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "South Beloit",
            "state": "IL",
            "postal_code": "610801431",
            "country_code": "US",
            "telephone_number": "608-368-8087",
            "fax_number": "608-312-2061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STATELINE MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-12",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "KNUEPPEL",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "608-217-7264",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beloit, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.