Inner Awakenings Diagnostic and Counseling Clinic

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

HFS61.91 Issued in WI

Legal business name

INNER AWAKENINGS DIAGNOSTIC AND COUNSELING CLINIC

Practice address

436 Oakton Ave
Pewaukee, WI 53072-3542

Phone

(262) 691-2581

Fax

(262) 691-2761

NPI assigned

May 10, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Melissa A Ford, MS,LPCNPI 1528272051

Title

Owner

Phone

(262) 691-2581

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melissa A Ford, M.S.,LPC

  • Professional Counselor
  • Waukesha, WI
  • NPI 1528272051

  Mental Health

  NPD (past) Authorized official
• Michael R Binder, M.D.

  • Psychologist
  • Highland Park, IL
  • NPI 1083632590
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266537600000",
    "number": "1679788103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 OAKTON AVE",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530723542",
            "telephone_number": "262-691-2581",
            "fax_number": "262-691-2761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 OAKTON AVE",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530723542",
            "telephone_number": "262-691-2581",
            "fax_number": "262-691-2761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER AWAKENINGS DIAGNOSTIC AND COUNSELING CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2010-02-19",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-691-2581",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS,LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "HFS61.91",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "HFS61.91",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42226000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2010; 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.