Active NPI
Jennifer A Nichols, LPC-IT, SAC
- Professional Counselor
- Onalaska, WI
National Provider Identifier
1871131482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4346-226
- Practice address
- 200 Mason St Ste 11
Onalaska, WI 54650-7061 - Phone
- (608) 769-6784
- NPI assigned
- Dec 13, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 16360-131 | WI | |
| Professional Counselor | 101YP2500X | 4346-226 | WI | Primary |
Addresses
Primary practice location
200 Mason St Ste 11
Onalaska, WI 54650-7061
Mailing address
200 Mason Street, Suite 11
Onalaska, WI 54650
Phone (608) 769-6784
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4346-226 | Other | WI | STATE OF WISCONSIN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://claritytherapycenter.com/ | Direct |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16360-131 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 4346-226 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583020800000",
"number": "1871131482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 MASON STREET, SUITE 11",
"city": "ONALASKA",
"state": "WI",
"postal_code": "54650",
"telephone_number": "608-769-6784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MASON ST STE 11",
"city": "ONALASKA",
"state": "WI",
"postal_code": "546507061",
"telephone_number": "608-769-6784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "JENNIFER",
"middle_name": "A",
"credential": "LPC-IT, SAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-13",
"last_updated": "2020-03-01",
"certification_date": "2020-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "16360-131",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "4346-226",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WISCONSIN",
"identifier": "4346-226",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://claritytherapycenter.com/",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Onalaska",
"address_1": "200 Mason St Ste 11",
"city": "Onalaska",
"state": "WI",
"country_code": "US",
"postal_code": "546507061",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 1, 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.