Kelly Thomack

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5455-125 Issued in WI

Practice address

5471 W Waterford LN
Appleton, WI 54913-8510

Phone

(920) 731-7445

Fax

(920) 731-7490

NPI assigned

Jun 20, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kellythomack@tdh.allscriptsdirect.net

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.

• Kelly Thomack Counseling

  • Mental Health Counselor
  • Appleton, WI
  • NPI 1669103057
  NPD Authorized official
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Counselor

  NPD
• County of Winnebago

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oshkosh, WI
  • NPI 1508960675
  NPD (past)

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1750796488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 E EDGEWOOD DR STE 105-540",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549139407",
            "telephone_number": "920-731-7445",
            "fax_number": "920-882-2946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5471 W WATERFORD LN",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138510",
            "telephone_number": "920-731-7445",
            "fax_number": "920-731-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMACK",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-20",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5455-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel John Thibodeau, D.C.
• Kelly Thiel, NP-C
• Maggie S Thiel, OT
• Stefanie Thiel
• Lisa R Thiltgen, APRN
• Stephanie Therese Thomas, MS, LPC
• Christine Ann Thompson, RN
• Katherine Thompson
• Kristen Sue Thompson, PTA
• Lauren Elizabeth Thompson, LPC-IT

• Professional Counselor in Appleton, WI
• Providers in Appleton, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; 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.