NPIMap

Organization Active NPI

Washington County Wisconsin

  • Community/Behavioral Health Agency
  • West Bend, WI
National Provider Identifier
1609801778
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1968 Issued in WI
Legal business name
WASHINGTON COUNTY WISCONSIN
Practice address
333 E. Washington Street
Suite 2100
West Bend, WI 53095-2585
Phone
(262) 335-4583
Fax
(262) 335-6827
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Eric Diamond
Title
Administrator
Phone
(262) 335-4591

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Community/Behavioral Health Agency 251S00000X 1968 WI Primary

Addresses

Primary practice location

333 E. Washington Street
Suite 2100
West Bend, WI 53095-2585

Mailing address

333 E. Washington Street
Suite 2100
West Bend, WI 53095-2585
Phone (262) 335-4583

Other identifiers 6

IdentifierTypeStateIssuer
41760200MedicaidWI
43071300MedicaidWI
42140400MedicaidWI
43422500MedicaidWI
32976700MedicaidWI
43107500MedicaidWI

Other names 1

  • Washington County Human Services Mental Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000487 WI Part B Supplier - Clinic/Group Practice 1951202142 Receives reassigned benefits from 18 practitioners
Practice locations: West Bend, WI

National Provider Directory

National Provider Directory
Tax ID family
Washington Co MH Ctr11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

333 E Washington St
West Bend, WI 53095
Phone (262) 335-4583

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1609801778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 E. WASHINGTON STREET",
            "address_2": "SUITE 2100",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952585",
            "telephone_number": "262-335-4583",
            "fax_number": "262-335-6827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 E. WASHINGTON STREET",
            "address_2": "SUITE 2100",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952585",
            "telephone_number": "262-335-4583",
            "fax_number": "262-335-6827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON COUNTY WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "DIAMOND",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "262-335-4591"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "1968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41760200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43071300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42140400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43422500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32976700",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43107500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington County Human Services Mental Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.