NPIMap

Organization Active NPI

Wisconsin Lutheran Child & Family Service, Inc

Doing business as Christian Family Counseling

  • Clinical Psychologist
  • Mankato, MN
National Provider Identifier
1669758520
Registry record updated Oct 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC
Doing business as
Christian Family Counseling
Practice address
44 Good Counsel Dr
Mankato, MN 56001-6599
Phone
(800) 438-1772
Fax
(262) 345-5531
NPI assigned
Oct 24, 2011
Last updated
Oct 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2019

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

Authorized official

Name
Mark Klug
Title
Ceo
Phone
(888) 655-9522

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

44 Good Counsel Dr
Mankato, MN 56001-6599

Mailing address

W175N11120 Stonewood Dr
Germantown, WI 53022-6511
Phone (262) 345-5560

Other names 1

  • CHRISTIAN FAMILY COUNSELING Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130627000261 MN Part B Supplier - Clinic/Group Practice 0749233898 Receives reassigned benefits from 21 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mankato, MN; North Mankato, MN; Rochester, MN

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

421 E Hickory St
Ste 402
Mankato, MN 56001

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570492800000",
    "number": "1669758520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W175N11120 STONEWOOD DR",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226511",
            "telephone_number": "262-345-5560",
            "fax_number": "262-345-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 GOOD COUNSEL DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016599",
            "telephone_number": "800-438-1772",
            "fax_number": "262-345-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-24",
        "last_updated": "2019-10-08",
        "status": "A",
        "authorized_official_last_name": "KLUG",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-655-9522"
    },
    "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTIAN FAMILY COUNSELING",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHRISTIAN FAMILY COUNSELING",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; 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.