COLUMBIA COUNTY COMMUNITY SUPPORT PROGRAM (NPI# 1154595551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154595551 |
| Entity Type | Organization |
| Organization Name | COLUMBIA COUNTY COMMUNITY SUPPORT PROGRAM |
| Practice Address |
2901 Hunters Trl Portage WI 53901-3403 |
| Mailing Address |
Po Box 301 Portage WI 53901-0301 |
| Practice Telephone | 6087454108 |
| Practice Fax Number | 6087424087 |
| Mailing Telephone | 6087454108 |
| Mailing Fax Number | 6087424087 |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-23 |
| Authorized Official Name | WENDY MIOTKE (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 6087454108 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
1212 | WI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 43429300 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467487538 | Columbia County Community Support Program | Clinic/Center | 2901 Hunters Trl, Portage, WI 53901-3403 | 2006-07-11 |
| Street Address |
2901 HUNTERS TRL |
| City | PORTAGE |
| State | WI |
| Zip Code | 53901-3403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912973942 | Andrew Taylor Putney | Family Medicine | 2901 Hunters Trl, Portage, WI 53901-3403 | 2006-02-28 |
| 1164086112 | Claire A Staley | Social Worker | 2901 Hunters Trl, Portage, WI 53901-3403 | 2019-04-25 |
| 1467826990 | Renee Birkholz | Counselor | 2901 Hunters Trl, Portage, WI 53901-3403 | 2015-11-20 |
| 1710363031 | Tomi Randall | Counselor | 2901 Hunters Trl, Portage, WI 53901-3403 | 2015-08-10 |
| 1144618604 | Kristine G Schmitt | Counselor | 2901 Hunters Trl, Portage, WI 53901-3403 | 2015-01-06 |
| 1700287216 | Jill Dickson-baures | Psychologist | 2901 Hunters Trl, Portage, WI 53901-3403 | 2014-09-16 |
| 1376944504 | Meredith Sullivan | Counselor | 2901 Hunters Trl, Portage, WI 53901-3403 | 2014-09-08 |
| 1619377223 | Bjorn Hanson | Psychologist | 2901 Hunters Trl, Portage, WI 53901-3403 | 2014-09-02 |
| 1649697988 | Elizabeth Abbs Erickson | Counselor | 2901 Hunters Trl, Portage, WI 53901-3403 | 2014-03-25 |
| 1124259841 | Robin A Deethardt | Counselor | 2901 Hunters Trl, Portage, WI 53901-3403 | 2009-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740710748 | Robert James Corliss | Internal Medicine | St. Vincent Fmc, 140east Cook St., Portage, WI 53901 | 2017-06-13 |
| 1639328867 | Casey Jo Ambort | Speech-Language Pathologist | 626 East Slifer St, Portage, WI 53901 | 2008-09-11 |
| 1871767400 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 132 W. Cook St., Portage, WI 53901 | 2008-04-15 |
| 1881872158 | Marta Jean Jindra | Physical Therapist | 626 E Slifer Street, Portage, WI 53901 | 2008-02-08 |
| 1699953976 | Lana Marie Edwards | Speech-Language Pathologist | 626 East Slifer Street, Portage, WI 53901 | 2008-02-08 |
| 1134314552 | Kristina Hellenbrand | Physical Therapist | 2639 New Pinery Road, Suite 2, Portage, WI 53901 | 2007-09-10 |
| 1689727810 | Gregory Allan Bindl | Chiropractor | 2121new Pinery Rd, Portage, WI 53901 | 2007-01-19 |
| 1720149156 | Timothy J Rosin Dds Sc | Dentist | 2570 New Pinery Rd, Portage, WI 53901 | 2006-12-12 |
| 1710083779 | Currani Seubert Dental Office LLC | Dentist | 260 W Cook St, Portage, WI 53901 | 2006-09-16 |
| 1225090525 | University of Wisconsin Medical Foundation Inc | Durable Medical Equipment & Medical Supplies | 2977 Cty Hwy Cx, Portage, WI 53901 | 2006-04-04 |
| Find all providers in zip 53901 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1043518079 | Insights Counseling LLC | Clinic/Center | 100 Shore Dr, Portage, IN 46368-1060 | 2011-02-28 |
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| 1730748724 | Molly Lubin Md LLC | Clinic/Center | 16 N Carroll St Ste 450-c, Madison, WI 53703-2716 | 2019-06-12 |
| 1346702826 | Kris Huenink Counseling Services LLC | Clinic/Center | 501 N 8th St Ste 110, Sheboygan, WI 53081-4461 | 2019-04-03 |
| 1720550981 | Purple Lotus Counseling LLC | Clinic/Center | 516 E Wisconsin Ave Ste C, Appleton, WI 54911-4864 | 2018-12-27 |
| 1831677079 | Creative Calm Counseling LLC | Clinic/Center | 2380 State Road 44 Ste G, Oshkosh, WI 54904-6440 | 2018-07-31 |
| 1407370398 | Tombolo, LLC | Clinic/Center | 12545 W. Burleigh Rd., Suite 10, Brookfield, WI 53005 | 2017-08-01 |
| 1730530239 | Home Away From Home Living Services LLC | Clinic/Center | 8127 W Herbert Ave, Milwaukee, WI 53218-3632 | 2016-06-26 |
| 1891149928 | Tcg Holdings 14, LLC | Clinic/Center | 127 N Franklin St Ste 206, Port Washington, WI 53074-1948 | 2016-04-14 |
| 1427410992 | Shelley Boehm Mattia Md,adult Psychiatry, LLC | Clinic/Center | 428 Doty St, Green Bay, WI 54301-4509 | 2016-03-24 |
| 1982002242 | Family & Childrens Center | Clinic/Center | 920 W Wisconsin St, Sparta, WI 54656-4217 | 2014-12-18 |
| 1154675924 | Northshore Clinic LLC | Clinic/Center | 805 N 6th St, Sheboygan, WI 53081-4113 | 2012-11-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.