Active NPI
Mary L Seubert, LPC, CSAC
- Professional Counselor
- Coloma, WI
National Provider Identifier
1962530170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4555-125
- Practice address
- 1519 3Rd Ave
Coloma, WI 54930-9406 - Phone
- (920) 647-6679
- NPI assigned
- Mar 1, 2007
- Last updated
- Jan 8, 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 | 1308 | WI | |
| Professional Counselor | 101YP2500X | 4555-125 | WI | Primary |
Addresses
Primary practice location
1519 3Rd Ave
Coloma, WI 54930-9406
Mailing address
1519 3Rd Ave
Coloma, WI 54930-9406
Phone (920) 647-6679
Other practice location 1
230 W Park St
Wautoma, WI 54982-9031
Phone (920) 787-6550
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1308-132 | Other | WI | STATE LICENSE |
| 4555-125 | Other | WI | STATE 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 |
|---|---|---|---|
| 1308 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 4555-125 | WI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546905600000",
"number": "1962530170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1519 3RD AVE",
"city": "COLOMA",
"state": "WI",
"postal_code": "549309406",
"telephone_number": "920-647-6679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1519 3RD AVE",
"city": "COLOMA",
"state": "WI",
"postal_code": "549309406",
"telephone_number": "920-647-6679"
}
],
"practiceLocations": [
{
"address_1": "230 W Park St",
"address_purpose": "LOCATION",
"city": "Wautoma",
"state": "WI",
"postal_code": "549829031",
"country_code": "US",
"telephone_number": "920-787-6550",
"fax_number": "920-787-0421",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SEUBERT",
"first_name": "MARY",
"middle_name": "L",
"credential": "LPC, CSAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2019-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "1308",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "4555-125",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "1308-132",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "4555-125",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.