1063501476 NPI number — NORTHWESTERN COUNSELING & SUPPORT SERVICES INC

Table of content: (NPI 1063501476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063501476 NPI number — NORTHWESTERN COUNSELING & SUPPORT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWESTERN COUNSELING & SUPPORT SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063501476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 FISHER POND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05478-6286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-524-6554
Provider Business Mailing Address Fax Number:
802-524-6562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 FISHER POND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05478-6286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-524-6554
Provider Business Practice Location Address Fax Number:
802-524-6562
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MABLE
Authorized Official First Name:
TED
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
802-524-6555

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1006428 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 491116 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1006107 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1006629 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 355023 . This is a "MHN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: FRAN6103 . This is a "BCBS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0006103 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009767 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009766 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2050939 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1007307 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN7031 . This is a "RR MEDICARE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 66316 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1001094 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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