NPIMap

Organization Active NPI

Christian Life Counseling LLC

Doing business as Christian Life Counseling

  • Clinical Psychologist
  • Brookfield, WI
National Provider Identifier
1659466860
Registry record updated Apr 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CHRISTIAN LIFE COUNSELING LLC
Doing business as
Christian Life Counseling
Practice address
12630 W North Ave BLDG E
Brookfield, WI 53005-4626
Phone
(262) 785-1008
Fax
(262) 462-3187
NPI assigned
Oct 4, 2006
Last updated
Apr 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2018

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

Authorized official

Name
Jennifer Mengo
Title
Administrator
Phone
(262) 785-1008

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Clinical Psychologist 103TC0700X Primary
Clinical Social Worker 1041C0700X
Marriage & Family Therapist 106H00000X

Addresses

Primary practice location

12630 W North Ave BLDG E
Brookfield, WI 53005-4626

Mailing address

12630 W North Ave BLDG E
Brookfield, WI 53005-4626
Phone (262) 785-1008

Other practice location 1

W175N11163 Stonewood Dr Ste 202
Germantown, WI 53022-6502
Phone (262) 785-1008

Other names 1

  • Christian Life Counseling Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061110000142 WI Part B Supplier - Clinic/Group Practice 8325046162 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Brookfield, WI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1659466860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12630 W NORTH AVE BLDG E",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054626",
            "telephone_number": "262-785-1008",
            "fax_number": "262-462-3187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12630 W NORTH AVE BLDG E",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054626",
            "telephone_number": "262-785-1008",
            "fax_number": "262-462-3187"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W175N11163 Stonewood Dr Ste 202",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "WI",
            "postal_code": "530226502",
            "country_code": "US",
            "telephone_number": "262-785-1008",
            "fax_number": "262-462-3187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHRISTIAN LIFE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "MENGO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "262-785-1008"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christian Life Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.