Nicholas Boortz
Individual provider Active NPI Professional Counselor · Brown Deer, WI
NPI 1598536385 · NPPES record last updated Jan 11, 2024
Key facts
- NPI
- 1598536385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 7742 (WI)
- Practice address
- 3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220 - Phone
- (414) 540-2170
- Fax
- (414) 540-2171
- NPI assigned
- Jan 11, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7742 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shorehaven Behavioral Health Inc | Professional | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 7742 | WI | Yes |
Addresses
Primary practice location
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Mailing address
3900 W Brown Deer Rd Ste 200
Brown Deer, WI 53209-1220
Phone (414) 540-2170
Other providers in Brown Deer, WI
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- Harrison Bjorback
- Corey Black
- Ashley Bland
- Carly Bolli
- Amanda Borchardt
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- Arlene Magon Braker
- Christina Brigham
- Samantha Ann Broghammer
All providers in Brown Deer, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.