NPIMap

Organization Active NPI

Spring Grove Counseling

  • Counselor
  • Jefferson City, MO
National Provider Identifier
1922352012
Registry record updated Oct 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
001621 Issued in MO
Legal business name
SPRING GROVE COUNSELING
Practice address
211 A Oscar Drive
Jefferson City, MO 65101-5167
Phone
(573) 635-8299
Fax
(573) 635-4629
NPI assigned
Oct 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2012

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

Authorized official

Name
Judy Kaye Wieberg, LPC, LCSW
Title
Owner/Director
Phone
(573) 635-8299

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X 001621 MO Primary
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X 002100 MO

Addresses

Primary practice location

211 A Oscar Drive
Jefferson City, MO 65101-5167

Mailing address

211 A Oscar Drive
Jefferson City, MO 65101-5167
Phone (573) 635-8299

Other identifiers 1

IdentifierTypeStateIssuer
493361109MedicaidMO

National Provider Directory

National Provider Directory

Locations

211 Oscar Dr
Ste A
Jefferson Cty, MO 65101
Phone (573) 635-8299

Practitioners & affiliated clinicians

Practitioners 12

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": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351468800000",
    "number": "1922352012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 A OSCAR DRIVE",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015167",
            "telephone_number": "573-635-8299",
            "fax_number": "573-635-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 A OSCAR DRIVE",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651015167",
            "telephone_number": "573-635-8299",
            "fax_number": "573-635-4629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING GROVE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-29",
        "last_updated": "2012-10-29",
        "status": "A",
        "authorized_official_last_name": "WIEBERG",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "KAYE",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "573-635-8299",
        "authorized_official_credential": "LPC, LCSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "MO",
            "license": "001621",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "MO",
            "license": "002100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "493361109",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; 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.