NPIMap

Organization Active NPI

Shore Counseling and Consulting Clinic, S.C.

  • Group Psychotherapy Psychologist
  • Milwaukee, WI
National Provider Identifier
1588710073
Registry record updated Aug 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Group Psychotherapy PsychologistTaxonomy code 103TP2701X
Legal business name
SHORE COUNSELING AND CONSULTING CLINIC, S.C.
Practice address
2600 N Mayfair Rd
Suite 650
Milwaukee, WI 53226-1309
Phone
(414) 771-9304
Fax
(414) 771-9543
NPI assigned
Jan 26, 2007
Last updated
Aug 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2015

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

Authorized official

Name
Thomas Troast, PHDNPI 1245386739
Title
Clinical Director
Phone
(414) 771-9304

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
Group Psychotherapy Psychologist 103TP2701X NU Primary

Addresses

Primary practice location

2600 N Mayfair Rd
Suite 650
Milwaukee, WI 53226-1309

Mailing address

2600 N Mayfair Rd
Suite 650
Milwaukee, WI 53226-1309
Phone (414) 771-9304

Other identifiers 1

IdentifierTypeStateIssuer
42247200MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040914000637 WI Part B Supplier - Clinic/Group Practice 3072580547 Receives reassigned benefits from 17 practitioners
Practice locations: Glendale, WI; South Milwaukee, WI; Wauwatosa, WI

National Provider Directory

National Provider Directory

Locations

2600 N Mayfair Rd
Ste 650
Wauwatosa, WI 53226
Phone (414) 771-9304

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1588710073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD",
            "address_2": "SUITE 650",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532261309",
            "telephone_number": "414-771-9304",
            "fax_number": "414-771-9543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 N MAYFAIR RD",
            "address_2": "SUITE 650",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532261309",
            "telephone_number": "414-771-9304",
            "fax_number": "414-771-9543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE COUNSELING AND CONSULTING CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "TROAST",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "414-771-9304",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42247200",
            "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 Aug 4, 2015; 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.