Active NPI
Bruce Davis, SAC
- Addiction (Substance Use Disorder) Counselor
- Appleton, WI
National Provider Identifier
1922323344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 15538-131
- Practice address
- 4000 W Spencer St
Appleton, WI 54914-4015 - Phone
- (920) 735-9010
- Fax
- (920) 735-9050
- NPI assigned
- Mar 29, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15538-131 | WI | Primary |
Addresses
Primary practice location
4000 W Spencer St
Appleton, WI 54914-4015
Mailing address
4000 W. Spencer St.
Appleton, WI 54914
Phone (920) 735-9010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15538-131 | Other | WI | SUBSTANCE ABUSE COUNSELOR LICENSE |
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 |
|---|---|---|---|
| 15538-131 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269820800000",
"number": "1922323344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 W. SPENCER ST.",
"city": "APPLETON",
"state": "WI",
"postal_code": "54914",
"telephone_number": "920-735-9010",
"fax_number": "920-735-9050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 W SPENCER ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549144015",
"telephone_number": "920-735-9010",
"fax_number": "920-735-9050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "BRUCE",
"credential": "SAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-29",
"last_updated": "2010-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "15538-131",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUBSTANCE ABUSE COUNSELOR LICENSE",
"identifier": "15538-131",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.