NPIMap

Organization Active NPI

Northwest Counseling and Guidance - Northwest Journey - Superior

  • Adolescent and Children Mental Health Clinic/Center
  • Superior, WI
National Provider Identifier
1982821575
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
2074 Issued in WI
Legal business name
NORTHWEST COUNSELING AND GUIDANCE - NORTHWEST JOURNEY - SUPERIOR
Practice address
1419 Hill Ave Ste B
Superior, WI 54880-1951
Phone
(715) 395-3805
Fax
(715) 424-5720
NPI assigned
Apr 18, 2007
Last updated
Oct 22, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST COUNSELING AND GUIDANCE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

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

Authorized official

Name
Mr. Nick Kalambokidis
Title
Cfo
Phone
(715) 327-4402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2074 WI Primary

Addresses

Primary practice location

1419 Hill Ave Ste B
Superior, WI 54880-1951

Mailing address

1412 E Second Street
Superior, ID 54880
Phone (715) 395-3805

Other identifiers 6

IdentifierTypeStateIssuer
HUMANAOtherHUMANA
42626OtherMNHEALTH PARTNERS
VALUE OPTIONSOtherVALUE OPTIONS
7H956NOOtherMNBCBS OF MN
85575OtherMNPREFERRED ONE
43004700MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Northwest Counseling Center22 organizations share this tax ID, including this one
Part of
Northwest Counseling Center

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

1419 Hill Ave
#B
Superior, WI 54880
Phone (715) 392-1955

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256169600000",
    "number": "1982821575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 E SECOND STREET",
            "city": "SUPERIOR",
            "state": "ID",
            "postal_code": "54880",
            "telephone_number": "715-395-3805",
            "fax_number": "715-424-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 HILL AVE STE B",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548801951",
            "telephone_number": "715-395-3805",
            "fax_number": "715-424-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST COUNSELING AND GUIDANCE - NORTHWEST JOURNEY - SUPERIOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST COUNSELING AND GUIDANCE CLINIC",
        "enumeration_date": "2007-04-18",
        "last_updated": "2009-10-22",
        "status": "A",
        "authorized_official_last_name": "KALAMBOKIDIS",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "715-327-4402",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "2074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "HUMANA",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "42626",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "VALUE OPTIONS",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "7H956NO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "85575",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43004700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Superior, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; 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.