| Open Door Center For Change Llc | |
|
6502 Grand Teton Plz Ste 102 Madison WI 53719-1047 | |
| (608) 827-7220 | |
| (608) 827-7223 |
| Full Name | Open Door Center For Change Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6502 Grand Teton Plz Ste 102, Madison, Wisconsin |
| Authorized Official Name and Position | Amy J Mosher-garvey (CO-OWNER) |
| Authorized Official Contact | 6088277220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Door Center For Change Llc 6502 Grand Teton Plz Ste 102 Madison WI 53719-1047 Ph: (608) 827-7220 | Open Door Center For Change Llc 6502 Grand Teton Plz Ste 102 Madison WI 53719-1047 Ph: (608) 827-7220 |
| NPI Number | 1215068069 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/07/2024 |
| Medicare PECOS PAC ID | 2860598711 |
|---|---|
| Medicare Enrollment ID | O20070509000503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215068069 | NPI | - | NPPES |
| 42198900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Amy J Mosher Garvey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831258060 PECOS PAC ID: 4587760442 Enrollment ID: I20110224000983 |
| Provider Name | Jennifer J Ebbott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013182419 PECOS PAC ID: 0143466490 Enrollment ID: I20130411000450 |
| Provider Name | Katherine M Hulbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548607963 PECOS PAC ID: 6608017322 Enrollment ID: I20130723000615 |
| Provider Name | Jennifer L Cummings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154591626 PECOS PAC ID: 7719119205 Enrollment ID: I20140416000603 |
| Provider Name | Christiam Albert Joseph |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467607259 PECOS PAC ID: 0648436964 Enrollment ID: I20150609001367 |
| Provider Name | Alena E Eichenseher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467933580 PECOS PAC ID: 6406107275 Enrollment ID: I20180919000048 |
| Provider Name | Lindsay A Jordan-zammuto |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164904991 PECOS PAC ID: 0749531515 Enrollment ID: I20180919000134 |
| Provider Name | Sally A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831607001 PECOS PAC ID: 2466889936 Enrollment ID: I20200221001501 |
| Provider Name | Nicole L Lyons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730687369 PECOS PAC ID: 2365856846 Enrollment ID: I20210124000038 |
| Provider Name | Heather H Douglas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265714992 PECOS PAC ID: 8224356480 Enrollment ID: I20231222001182 |
| Provider Name | Jeni A Nestler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184272973 PECOS PAC ID: 5496105033 Enrollment ID: I20231222001981 |
| Provider Name | Karyl L Meister |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043456072 PECOS PAC ID: 9537519863 Enrollment ID: I20231228000783 |
| Provider Name | Natalie J Duhr Stowell |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861733032 PECOS PAC ID: 6103276373 Enrollment ID: I20231229002230 |
| Provider Name | William Hector |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942534953 PECOS PAC ID: 2062864317 Enrollment ID: I20240123000617 |
| Provider Name | Heather W Seeley-schreck |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1417022922 PECOS PAC ID: 0244683712 Enrollment ID: I20240131003618 |
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