SHELLEY BOEHM MATTIA MD,ADULT PSYCHIATRY, LLC (NPI# 1427410992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427410992 |
| Entity Type | Organization |
| Organization Name | SHELLEY BOEHM MATTIA MD,ADULT PSYCHIATRY, LLC |
| Practice Address |
428 Doty St Green Bay WI 54301-4509 |
| Practice Telephone | 9209656768 |
| Practice Fax Number | 9209656769 |
| Mailing Telephone | 9209656768 |
| Mailing Fax Number | 9209656769 |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-10-04 |
| Authorized Official Name | DR. SHELLEY KATHRYN BOEHM MATTIA (LICENSED PHYSICIAN) |
| Authorized Official Telephone | 9202464925 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
39641 | WI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32453500 | 05 |
| Street Address |
428 DOTY ST |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54301-4509 |
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| 1598229478 | Shaina Marie Conner | Registered Nurse | 835 S Vanburen St, Green Bay, WI 54301 | 2019-01-25 |
| 1093298960 | Brown County | Case Management | 111 N. Jefferson Street, Green Bay, WI 54301 | 2018-09-07 |
| 1639609928 | Frontline Healthcare LLC | Specialist/Technologist, Other | 2221 S. Webster Ave. Suite 270, Greenbay, WI 54301 | 2017-06-19 |
| 1992242606 | Charmaine Rimple | Counselor | 526 South Monroe Avenue, Green Bay, WI 54301 | 2017-01-20 |
| 1962944819 | Rebecca Lucille Reinbold | Registered Nurse | 917 Catherine Street, Green Bay, WI 54301 | 2016-11-09 |
| 1730635061 | Melissa Kristof | Specialist/Technologist, Other | 1821 Sounth Webster Ave., Green Bay, WI 54301 | 2016-08-28 |
| 1255709747 | Vivian Sweetheart Bishop-cook | Counselor | 2920 South Webster Ave, Green Bay, WI 54301 | 2015-09-14 |
| 1881079960 | Chelsi S Weber | Registered Nurse | 2300 Riverside Dr., Ste 204, Green Bay, WI 54301 | 2015-07-30 |
| 1962816371 | Joelle M Hesse | Counselor | 630 Cherry St., Green Bay, WI 54301 | 2014-06-13 |
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| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033349436 | Gam Behavioral Health Services LLC | Clinic/Center | 3021 Holmgren Way, Suite 203a, Green Bay, WI 54304-6302 | 2009-07-20 |
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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 |
| 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 |
| 1003179953 | Thundermist, Inc. | Clinic/Center | 2108a Silvernail Rd, Suite 116, Pewaukee, WI 53072-5526 | 2012-06-15 |
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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.