1487052494 NPI number — GUIDED PATH COUNSELING, LLC

Table of content: (NPI 1487052494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487052494 NPI number — GUIDED PATH COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUIDED PATH COUNSELING, LLC
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:
1487052494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
641 MONROE ST
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
SHEBOYGAN FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53085-1358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-627-2793
Provider Business Mailing Address Fax Number:
920-550-0014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
641 MONROE ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
SHEBOYGAN FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53085-1358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-627-2793
Provider Business Practice Location Address Fax Number:
920-550-0014
Provider Enumeration Date:
12/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GROH
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
920-627-2793

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  4834-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346505021 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com