Kory Eichers Mather Douglass

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

754-228 Issued in WI

Practice address

5979 Siggelkow Rd
McFarland, WI 53558-9817

Phone

(608) 838-8999

NPI assigned

Sep 14, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kory Eichers Douglass Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Common Threads Family Resource Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Madison, WI
  • NPI 1386808384
  NPD
• Catholic Charities, Inc. Roman Catholic Diocese

  • Community/Behavioral Health Agency
  • MC Farland, WI
  • NPI 1962752402
  NPD (past)

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

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1760097075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 CENTER ST",
            "city": "PRAIRIE DU SAC",
            "state": "WI",
            "postal_code": "535781212",
            "telephone_number": "414-379-5756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5979 SIGGELKOW RD",
            "city": "MCFARLAND",
            "state": "WI",
            "postal_code": "535589817",
            "telephone_number": "608-838-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "KORY",
        "middle_name": "EICHERS MATHER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-14",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "754-228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KORY",
            "last_name": "DOUGLASS",
            "middle_name": "EICHERS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cooper Therapy and Wellness
• Ann Cooper
• Gabrielle Renee Courseault, BSN, RN, CPN
• Dane Dental LLC
• Brian M Doolan, DPT
• Angela Eilbes, CCC-SLP
• Alicia Ellison, RN
• David J Ende, MD
• Christine Fifarek, LPN
• Kaitlyn Flamand, DC

• All providers in McFarland, WI
• Marriage & Family Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; 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.