NPIMap

Organization Active NPI

Professional Services Group, Inc.

  • Mental Health Counselor
  • Oshkosh, WI
National Provider Identifier
1598080525
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1749 Issued in WI
Legal business name
PROFESSIONAL SERVICES GROUP, INC.
Practice address
220 Washington Avenue
Oshkosh, WI 54903
Phone
(920) 237-6990
Fax
(920) 424-7521
NPI assigned
Apr 1, 2010
Last updated
May 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2010

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

Authorized official

Name
Brian A Wolf, PHD
Title
Clinical Director
Phone
(414) 727-2789

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 1749 WI
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 1749 WI Primary

Addresses

Primary practice location

220 Washington Avenue
Oshkosh, WI 54903

Mailing address

1126 S. 70TH Street
Suite S-507
West Allis, WI 53214-3151
Phone (414) 727-2789

Other identifiers 1

IdentifierTypeStateIssuer
000084462OtherWIMEDICARE ID - TYPE UNSPECIFIED

National Provider Directory

National Provider Directory
Tax ID family
Professional Services Group Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1598080525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1126 S. 70TH STREET",
            "address_2": "SUITE S-507",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143151",
            "telephone_number": "414-727-2789",
            "fax_number": "414-476-8695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 WASHINGTON AVENUE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "54903",
            "telephone_number": "920-237-6990",
            "fax_number": "920-424-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL SERVICES GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-01",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "414-727-2789",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "1749",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "1749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "000084462",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; 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.