Organization Active NPI

Innerchange, Inc.

  • Mental Health Counselor
  • Onalaska, WI
National Provider Identifier
1770634370
Registry record updated Mar 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1435 Issued in WI
Legal business name
INNERCHANGE, INC.
Practice address
1401 Main St
Onalaska, WI 54650-2858
Phone
(608) 783-2186
Fax
(608) 781-3405
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2009

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

Authorized official

Name
Mr. Thomas B Roberts, LCSW
Title
President
Phone
(608) 783-2186

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 1435 WI Primary

Addresses

Primary practice location

1401 Main St
Onalaska, WI 54650-2858

Mailing address

1401 Main St
Onalaska, WI 54650-2858
Phone (608) 783-2186

Other identifiers 1

IdentifierTypeStateIssuer
42165700MedicaidWI

National Provider Directory

National Provider Directory

Locations

1401 Main St
Onalaska, WI 54650
Phone (608) 783-2186

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1770634370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MAIN ST",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546502858",
            "telephone_number": "608-783-2186",
            "fax_number": "608-781-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MAIN ST",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546502858",
            "telephone_number": "608-783-2186",
            "fax_number": "608-781-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNERCHANGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-783-2186",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "1435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42165700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Onalaska, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; 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.