Kevin J Montague, MS, LPC, LSAC, LSW
Individual provider Active NPI Professional Counselor · Balsam Lake, WI
NPI 1992078828 · NPPES record last updated May 10, 2017
Key facts
- NPI
- 1992078828
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 6332-125 (WI)
- Practice address
- 100 Polk County PLZ
Ste 50
Balsam Lake, WI 54810-9071 - Phone
- (715) 485-8862
- Fax
- (715) 485-8450
- NPI assigned
- Feb 23, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Polk County-Dept of Administration
Practice addresses (Care Compare)
100 Polk County PLZ
Suite 180
Balsam Lake, WI 54810-8009
Phone (715) 485-8563
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251021001239 | WI | Practitioner - Mental Health Counselor | 4688162894 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15908-132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 8078-120 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 6332-125 | WI | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Polk County Dept of Administration | Current |
Accepting new patients | |
| Polk County-Dept of Administration | Current |
Accepting new patients |
Locations
100 Polk County Plz
Ste 50
Balsam Lake, WI 54810
Phone (715) 485-8400
100 Polk County Plz
Ste 180
Balsam Lake, WI 54810
Phone (715) 485-8500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 8078-120 | WI | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 15908-132 | WI | |
| Professional Counselor | 101YP2500X | 6332-125 | WI | Yes |
Addresses
Primary practice location
100 Polk County PLZ
Ste 50
Balsam Lake, WI 54810-9071
Mailing address
100 Polk County PLZ
Ste 50
Balsam Lake, WI 54810-9071
Phone (715) 485-8862
Other providers in Balsam Lake, WI
- Leah Loeffler
- Anita Lundquist
- Kathleen M McGurran
- Brian Longhurst Merrill
- Sara C Meuth
- David N Moore
- Gerry R Morgan
- Emily C Ovik
- Cynthia J Peer
- Gail Peterson
All providers in Balsam Lake, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.