OPEN DOOR CENTER FOR CHANGE SC (NPI# 1215068069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215068069 |
| Entity Type | Organization |
| Organization Name | OPEN DOOR CENTER FOR CHANGE SC |
| Practice Address |
6502 Grand Teton Plz Suite 206 Madison WI 53719-1047 |
| Practice Telephone | 6088277220 |
| Practice Fax Number | 6088277223 |
| Mailing Telephone | 6088277220 |
| Mailing Fax Number | 6088277223 |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-06-04 |
| Authorized Official Name | MS. AMY J MOSHER-GARVEY (CO-OWNER) |
| Authorized Official Telephone | 6088277220 |
| Authorized Official Credential | LCSW, CSAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 2026 | WI | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 42198900 | 05 |
| Street Address |
6502 GRAND TETON PLZ SUITE 206 |
| City | MADISON |
| State | WI |
| Zip Code | 53719-1047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023114121 | Cathy A. Propper | Psychologist | 6502 Grand Teton Plz, 206, Madison, WI 53719-1047 | 2006-09-15 |
| 1831607001 | Sally A Jackson | Social Worker | 6502 Grand Teton Plz, Madison, WI 53719-1047 | 2018-01-22 |
| 1710423108 | Crystal Sheehy | Marriage & Family Therapist | 6502 Grand Teton Plz, Suite 204, Madison, WI 53719-1047 | 2017-01-10 |
| 1366869612 | Petrovnia Fernande Mcintosh | Social Worker | 6502 Grand Teton Plz, Suite 102, Madison, WI 53719-1047 | 2014-03-25 |
| 1861733032 | Natalie Jean Duhr | Marriage & Family Therapist | 6502 Grand Teton Plz, Madison, WI 53719-1047 | 2013-03-12 |
| 1265714992 | Heather H Douglas | Counselor | 6502 Grand Teton Plz, Suite 203, Madison, WI 53719-1047 | 2011-09-20 |
| 1699081109 | Evergreen Counseling Services, LLC | Clinic/Center | 6502 Grand Teton Plz, Madison, WI 53719-1047 | 2010-08-20 |
| 1457683252 | Anne Olivia Mesich | Counselor | 6502 Grand Teton Plz, Madison, WI 53719-1047 | 2010-02-03 |
| 1245569730 | Sandrea Voeller | Radiologic Technologist | 6502 Grand Teton Plz, Suite 105, Madison, WI 53719-1047 | 2009-12-14 |
| 1568594372 | Tami Ra Bahr | Counselor | 6502 Grand Teton Plz, Suite 102, Madison, WI 53719 | 2007-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689271801 | Jessica Seidel | Registered Nurse | 1015 Gammon Lane, Madison, WI 53719 | 2020-10-01 |
| 1376168989 | 360 Wellness LLC | Physical Therapist | 504 S Yellowstone Lane, Madison, WI 53719 | 2020-06-09 |
| 1932744067 | Sara Ruiz | Marriage & Family Therapist | Clock Tower Office Park, 6333 Odana Rd, #20, Madison, WI 53719 | 2019-11-13 |
| 1700436466 | David R. Gosling | Counselor | 702 South High Point Road #209, Madison, WI 53719 | 2019-09-16 |
| 1285289587 | Clifton Leo Davis Jr. | Counselor | 6417 O Dana Rd #5, Madison, WI 53719 | 2019-08-05 |
| 1679127278 | Akillah Jamillah Wali | Psychologist | 6417 Odana Rd Suite 5, Madison, WI 53719 | 2019-07-31 |
| 1689230211 | Brandy Georgecopeland | Marriage & Family Therapist | 6417 Odana Rd. Ste 5, Madison, WI 53719 | 2019-05-20 |
| 1275016826 | Kelsey Andersen | Physical Therapist | 504 S. Yellowstone Lane, Madison, WI 53719 | 2018-09-10 |
| 1740797190 | Catelyn Schwerke | Social Worker | 3848 Maple Grove Dr, Apt 307, Madison, WI 53719 | 2018-01-08 |
| 1922519008 | Mary Jane Cruz Delorme | Registered Nurse | 6831 Mader Dr. #210, #210, Madison, WI 53719 | 2017-10-17 |
| Find all providers in zip 53719 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871141366 | Boone Memorial Hospital, Inc. | Community/Behavioral Health | 467 Main St Ste 4, Madison, WV 25130-2200 | 2019-08-28 |
| 1154838399 | Leslie Smith Lpc LLC | Community/Behavioral Health | 650 Sun Temple Dr, Madison, AL 35758-8621 | 2018-01-09 |
| 1497268817 | Imagine A Childs Capacity LLC | Community/Behavioral Health | 128 E Olin Ave Ste 201, Madison, WI 53713-1467 | 2017-11-07 |
| 1316464191 | Shore Wellness Ct | Community/Behavioral Health | 85b Wall St, Madison, CT 06443-3121 | 2017-08-23 |
| 1407302532 | Aba Steps LLC | Community/Behavioral Health | 3 Niles Ave, Madison, NJ 07940-2310 | 2016-08-29 |
| 1245786680 | Michelle Ayres, Ms, Lmft | Community/Behavioral Health | 111 S 1st St # 103, Madison, WI 53704-5244 | 2016-08-26 |
| 1124471412 | Lifeworks Counseling | Community/Behavioral Health | 940 Ebenezer Blvd., Madison, MS 39110 | 2016-07-21 |
| 1184078628 | Bridgeway Counseling | Community/Behavioral Health | 540 Hughes Rd Ste 3, Madison, AL 35758-8959 | 2016-04-21 |
| 1588022206 | Moore Counseling Services | Community/Behavioral Health | 808 Nw 3rd St, Madison, SD 57042-2518 | 2016-02-09 |
| 1073988051 | Killebrew Psychological Services, LLC | Community/Behavioral Health | 133 Berry Ln, Madison, MS 39110-8616 | 2015-12-02 |
| Find all providers in MADISON | ||||
Please comment or provide details below to improve the information on OPEN DOOR CENTER FOR CHANGE SC.
| 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.