PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC, LLC (NPI# 1609046788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609046788 |
| Entity Type | Organization |
| Organization Name | PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC, LLC |
| Practice Address |
5801 Washington Ave Ste 103 Racine WI 53406-4057 |
| Mailing Address |
5801 Washington Ave Ste 110 Racine WI 53406-4057 |
| Practice Telephone | 2628849734 |
| Practice Fax Number | 2628849735 |
| Mailing Telephone | 2628849734 |
| Mailing Fax Number | 2628849735 |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2011-02-15 |
| Authorized Official Name | MRS. ALICE FAYE PORTIS-PATTERSON (CLINICAL DIRECTOR/THERAPIST) |
| Authorized Official Telephone | 2628849734 |
| Authorized Official Credential | MSW, LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
947-125 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 39228200 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PORTIS MARRIAGE AND CHILDREN COUNSELING CLINIC, LLC | 5801 Washington Ave Ste 110, Racine, WI 53406-4057 |
| Street Address |
5801 WASHINGTON AVE STE 103 |
| City | RACINE |
| State | WI |
| Zip Code | 53406-4057 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164349 | Lynn Huynh | Pharmacist | 5695 Washington Ave, Racine, WI 53406 | 2020-11-06 |
| 1659920049 | Carol Jean Cornejo | Technician | 6528 Heritage Avenue, Mt Pleasant, WI 53406 | 2019-09-09 |
| 1265913958 | Mary Goldbeck | Social Worker | 1775 Newman Rd, Mt Pleasant, WI 53406 | 2018-08-22 |
| 1669963344 | Kelly Nicole Nelson | Registered Nurse | 8800 Washington Ave Ste 200, Mount Pleasant, WI 53406 | 2018-05-29 |
| 1891212163 | Ilona Agata Pryomski | Nurse Practitioner | 9201 Washington Ave, Racine, WI 53406 | 2017-08-27 |
| 1386185106 | Margaret M. Abaogye Dds | Dentist | 4340 Newman Rd., Racine, WI 53406 | 2017-03-13 |
| 1508309212 | Rebecca Koeppen | Dietitian, Registered | 8400 Washington Ave., Racine, WI 53406 | 2016-11-29 |
| 1386194371 | Forefront Dermatology, S.c. | Dermatology | 7200 Washington Ave, Suite 100, Mount Pleasant, WI 53406 | 2016-10-13 |
| 1356891402 | Forefront Dermatology, S.c. | Dermatology | 1515 S Green Bay Rd, Racine, WI 53406 | 2016-10-12 |
| 1861841470 | Leah Marie Johnson | Dentist | 1101 South Airline Road, Racine, WI 53406 | 2016-06-06 |
| Find all providers in zip 53406 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881220408 | Denise Petrelli-holst | Counselor | 2515 1st St, Racine, WI 53403-9649 | 2020-03-15 |
| 1609106616 | Natalie Caye Fecht | Counselor | 4635 Erie St, Racine, WI 53402-2818 | 2010-01-14 |
| 1699933036 | Theresa Dewalt | Counselor | 1220 Mound Ave Ste 304, Racine, WI 53404-3350 | 2008-05-31 |
| 1255340642 | Michael Allen Boticki | Counselor | 1220 Mound Ave Ste 301, Racine, WI 53404-3350 | 2006-08-05 |
| 1447204953 | Amy Sprague Champeau | Counselor | 102 10th St, Racine, WI 53403-1513 | 2006-05-20 |
| 1013539477 | Kelly Jean Smith | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2020-05-08 |
| 1841832474 | Dora Ann Caldwell | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2019-10-15 |
| 1285005082 | John Vianney Muweesi | Counselor | 800 Wisconsin Ave, Racine, WI 53403-1526 | 2015-10-19 |
| 1194101550 | Alexander Jeske | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2015-08-07 |
| 1558615773 | Gregory Lautz | Counselor | 1717 Taylor Ave, Racine, WI 53403-2405 | 2012-11-09 |
| Find all providers in RACINE | ||||
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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.