Active NPI
Mari J Kriescher, MS,LPC,CSAC,ICS
- Professional Counselor
- Green Bay, WI
National Provider Identifier
1629068192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4693-125
- Practice address
- 2640 W Point Rd
Green Bay, WI 54304-1344 - Phone
- (920) 869-2711
- NPI assigned
- Oct 26, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 11704-132 | WI | |
| Clinical Social Worker | 1041C0700X | 11704 | WI | |
| Professional Counselor | 101YP2500X | 4693-125 | WI | Primary |
Addresses
Primary practice location
2640 W Point Rd
Green Bay, WI 54304-1344
Mailing address
PO Box 365
Oneida, WI 54155-0365
Phone (920) 896-2711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39393400 | Medicaid | WI |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11704-132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 4693-125 | WI | MD | Professional Counselor |
| 11704 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oneida Nation | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Ka Ni Kuhli Yo Family Center
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Green Bay, WI
- NPI 1205825130
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611187200000",
"number": "1629068192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 365",
"city": "ONEIDA",
"state": "WI",
"postal_code": "541550365",
"telephone_number": "920-896-2711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2640 W POINT RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543041344",
"telephone_number": "920-869-2711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRIESCHER",
"first_name": "MARI",
"middle_name": "J",
"credential": "MS,LPC,CSAC,ICS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-26",
"last_updated": "2021-01-21",
"certification_date": "2021-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "11704-132",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "11704",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "4693-125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39393400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.