Individual provider Active NPI

Christine T Le Grand, LPC, ATRL-BC

  • Professional Counselor
  • Glendale, WI
National Provider Identifier
1619010790
Registry record updated Sep 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
3878-125 Issued in WI
Practice address
6789 N Green Bay Rd
Glendale, WI 53209-3472
Phone
(414) 828-1856
NPI assigned
Feb 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 59-136 WI
Professional Counselor 101YP2500X 3878-125 WI Primary

Addresses

Primary practice location

6789 N Green Bay Rd
Glendale, WI 53209-3472

Mailing address

5948 N Santa Monica Blvd
Whitefish Bay, WI 53217-4618
Phone (414) 828-1856

Other identifiers 1

IdentifierTypeStateIssuer
40948900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
59-136WIMDMental Health Counselor
3878-125WIMDProfessional Counselor

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253232000000",
    "number": "1619010790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5948 N SANTA MONICA BLVD",
            "city": "WHITEFISH BAY",
            "state": "WI",
            "postal_code": "532174618",
            "telephone_number": "414-828-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6789 N GREEN BAY RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093472",
            "telephone_number": "414-828-1856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE GRAND",
        "first_name": "CHRISTINE",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "LPC, ATRL-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2009-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "59-136",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "3878-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40948900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2009; 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.