Individual provider Active NPI

Taylor Wilson, LPC

  • Professional Counselor
  • Brookfield, WI
National Provider Identifier
1972136984
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
8641-225 Issued in WI
Practice address
17100 W North Ave Ste 300
Brookfield, WI 53005-4436
Phone
(262) 244-6177
Fax
(262) 299-3040
NPI assigned
Feb 18, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 8641-225 WI Primary
Professional Counselor 101YP2500X 4566-226 WI

Addresses

Primary practice location

17100 W North Ave Ste 300
Brookfield, WI 53005-4436

Mailing address

1035 W Glen Oaks LN Ste 110
Mequon, WI 53092-3392
Phone (262) 244-6178

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241008002556 WI Practitioner - Mental Health Counselor 3173054632 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornerstone Counseling Services IncGroup PAC ID 1456256023, 338 clinicians

Practice addresses (Care Compare)

17100 W N Ave
Suite 300
Brookfield, WI 53005-4436
Phone (262) 244-6177

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4566-226WIMDProfessional Counselor
8641-225WIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc CurrentSince Aug 1, 2024 Accepting new patients
Multicultural Trauma and Addiction Treatment Center of Wisconsin Professional PastSince Feb 1, 2020 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909

17100 W North Ave
Ste 300
Brookfield, WI 53005
Phone (262) 244-6177

1035 W Glen Oaks Ln
Ste 110
Mequon, WI 53092
Phone (262) 240-0299

1143 Warwick Way
Racine, WI 53406
Phone (262) 321-0110

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.taylorwilson@149809.advancedmd-direct.com

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1972136984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 W GLEN OAKS LN STE 110",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923392",
            "telephone_number": "262-244-6178",
            "fax_number": "262-299-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 W NORTH AVE STE 300",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054436",
            "telephone_number": "262-244-6177",
            "fax_number": "262-299-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TAYLOR",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "8641-225",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4566-226",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.