Individual provider Active NPI

Olivia Berley

  • Professional Counselor
  • Oak Creek, WI
National Provider Identifier
1730922741
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
7280 S 13TH St
Oak Creek, WI 53154-1831
Phone
(262) 334-4340
Fax
(262) 334-4341
NPI assigned
Jun 17, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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 Primary

Addresses

Primary practice location

7280 S 13TH St
Oak Creek, WI 53154-1831

Mailing address

400 W River Dr
West Bend, WI 53090-1518
Phone (262) 334-4340

Other practice location 1

400 W River Dr
West Bend, WI 53090-1518
Phone (262) 334-4340

Other practice location 2

W62N281 Washington Ave
Cedarburg, WI 53012-2737
Phone (262) 334-4340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260410000958 WI Practitioner - Mental Health Counselor 3274008990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Kettle Moraine Counseling LLCGroup PAC ID 8527353747, 20 clinicians

Practice addresses (Care Compare)

400 W River Dr
West Bend, WI 53090-1518
Phone 262334434013

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kettle Moraine Counseling LLC CurrentSince Jun 23, 2024 Accepting new patients
Cedarburg Physical Therapy, Inc PastSince Aug 1, 2001 Accepting new patients
Affiliated Clinical Services Inc PastSince Jun 23, 2024 Accepting new patients

Locations

W62N281 Washington Ave
Cedarburg, WI 53012
Phone (262) 334-4340

400 W River Dr
West Bend, WI 53090
Phone (262) 334-4340

Organizations & group practices 3

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": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1730922741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W RIVER DR",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530901518",
            "telephone_number": "262-334-4340",
            "fax_number": "262-334-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7280 S 13TH ST",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531541831",
            "telephone_number": "262-334-4340",
            "fax_number": "262-334-4341"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 W River Dr",
            "address_purpose": "LOCATION",
            "city": "West Bend",
            "state": "WI",
            "postal_code": "530901518",
            "country_code": "US",
            "telephone_number": "262-334-4340",
            "fax_number": "262-334-4341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "W62N281 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Cedarburg",
            "state": "WI",
            "postal_code": "530122737",
            "country_code": "US",
            "telephone_number": "262-334-4340",
            "fax_number": "262-334-4341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERLEY",
        "first_name": "OLIVIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Creek, WI

Sources for this page

Verify at the official NPI Registry.