Active NPI
Mark Alan Tegtmeier, MA, LCSW, LPC, LMFT
- Clinical Social Worker
- New London, WI
National Provider Identifier
1821263849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2364-123
- Practice address
- E7475 Rawhide Rd
New London, WI 54961 - Phone
- (920) 982-6100
- Fax
- (920) 982-5040
- NPI assigned
- Apr 30, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1863-125 | WI | |
| Clinical Social Worker | 1041C0700X | 2364-123 | WI | Primary |
| Marriage & Family Therapist | 106H00000X | 479-124 | WI |
Addresses
Primary practice location
E7475 Rawhide Rd
New London, WI 54961
Mailing address
E7475 Rawhide Rd
New London, WI 54961
Phone (920) 982-6100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39273400 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1863-125 | WI | MD | Professional Counselor |
| 2364-123 | WI | MD | Clinical Social Worker |
| 479-124 | WI | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rawhide Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- New London, WI
- NPI 1841334620
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1821263849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "E7475 RAWHIDE RD",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "54961",
"telephone_number": "920-982-6100",
"fax_number": "920-982-5040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "E7475 RAWHIDE RD",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "54961",
"telephone_number": "920-982-6100",
"fax_number": "920-982-5040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEGTMEIER",
"first_name": "MARK",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "MA, LCSW, LPC, LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-30",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "1863-125",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "2364-123",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WI",
"license": "479-124",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39273400",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, WI
- St Joseph Residence Inc
- Pamela J. St. Clair, P.T.
- St. Joseph Residence, Inc. - the Washington Center
- Sundance Services Corp (Genesis Rehab Services)
- Craig E Sylte, O.D.
- Marcella K Teske, APNP
- The Pharmacy of New London Inc. (Jernegan's Health Mart Pharmacy)
- Thedacare Medical Center - New London, Inc
- Thedacare Medical Center - New London, Inc
- Thedacare Medical Center - New London, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.