NPIMap

Organization Active NPI

Innervisions Counseling & Consulting Center, S.C.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baraboo, WI
National Provider Identifier
1639402902
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
INNERVISIONS COUNSELING & CONSULTING CENTER, S.C.
Practice address
840 State Road 136 Ste 1
Baraboo, WI 53913-9252
Phone
(608) 477-9858
Fax
(877) 560-0578
NPI assigned
Sep 17, 2009
Last updated
Jan 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Authorized official

Name
Ms. Colleen Suzanna James, LPC, LCSW, CSACNPI 1598829897
Title
Director
Phone
(608) 477-9858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 133 WI
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X #2 WI
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X #123 WI
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

840 State Road 136 Ste 1
Baraboo, WI 53913-9252

Mailing address

840 State Road 136 Ste 1
Baraboo, WI 53913-9252
Phone (608) 477-9858

Other identifiers 1

IdentifierTypeStateIssuer
39602100MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140219000852 WI Part B Supplier - Clinic/Group Practice 8527297498 Receives reassigned benefits from 1 practitioner
Practice locations: Baraboo, WI

National Provider Directory

National Provider Directory

Locations

840 State Road 136
Ste 1
Baraboo, WI 53913
Phone (608) 477-9858

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1639402902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 STATE ROAD 136 STE 1",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539139252",
            "telephone_number": "608-477-9858",
            "fax_number": "877-560-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 STATE ROAD 136 STE 1",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539139252",
            "telephone_number": "608-477-9858",
            "fax_number": "877-560-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERVISIONS COUNSELING & CONSULTING CENTER, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-17",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "SUZANNA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "608-477-9858",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC, LCSW, CSAC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "133",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "#2",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "#123",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39602100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baraboo, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.