NPIMap

Organization Active NPI

Great Lakes Clinic and Consultants

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sheboygan, WI
National Provider Identifier
1780159004
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GREAT LAKES CLINIC AND CONSULTANTS
Practice address
1407 North 8TH Street
Suite 203
Sheboygan, WI 53081
Phone
(920) 415-0505
NPI assigned
Oct 13, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Authorized official

Name
David Dich, LCSWNPI 1215320908
Title
Ceo
Phone
(920) 415-0505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1407 North 8TH Street
Suite 203
Sheboygan, WI 53081

Mailing address

1407 North 8TH Street
Suite 203
Sheboygan, WI 53081
Phone (920) 415-0505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250421001975 WI Part B Supplier - Clinic/Group Practice 9335664549 Receives reassigned benefits from 2 practitioners
Practice locations: Sheboygan, WI

National Provider Directory

National Provider Directory

Locations

1407 N 8th St
Ste 203
Sheboygan, WI 53081
Phone (920) 415-0505

Practitioners & affiliated clinicians

Practitioners 7

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": "1539388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1780159004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 NORTH 8TH STREET",
            "address_2": "SUITE 203",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "53081",
            "telephone_number": "920-415-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 NORTH 8TH STREET",
            "address_2": "SUITE 203",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "53081",
            "telephone_number": "920-415-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES CLINIC AND CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-13",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "DICH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "920-415-0505",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheboygan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.