Individual provider Active NPI

David Tice, MS, LPC

  • Professional Counselor
  • Wausau, WI
National Provider Identifier
1649686973
Registry record updated Sep 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5350-125 Issued in WI
Practice address
631 Forest St
Wausau, WI 54403-5524
Phone
(715) 842-0944
Fax
(715) 845-6477
NPI assigned
Jul 8, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 5350-125 WI Primary

Addresses

Primary practice location

631 Forest St
Wausau, WI 54403-5524

Mailing address

631 Forest St
Wausau, WI 54403-5524
Phone (715) 842-0944

Other identifiers 1

IdentifierTypeStateIssuer
1649686973MedicaidWI

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

LicenseStateTypeSpecialty
5350-125WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Human Development, Inc. PastSince Jul 1, 1990 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410220800000",
    "number": "1649686973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 FOREST ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544035524",
            "telephone_number": "715-842-0944",
            "fax_number": "715-845-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 FOREST ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544035524",
            "telephone_number": "715-842-0944",
            "fax_number": "715-845-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICE",
        "first_name": "DAVID",
        "credential": "MS, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-08",
        "last_updated": "2014-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5350-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649686973",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; 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.