Provider Demographics
NPI:1427677467
Name:MICHAEL NOLL COUNSELING, LLC
Entity type:Organization
Organization Name:MICHAEL NOLL COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-215-1553
Mailing Address - Street 1:1477 KENWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1160
Mailing Address - Country:US
Mailing Address - Phone:920-215-1553
Mailing Address - Fax:920-821-1432
Practice Address - Street 1:1477 KENWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1160
Practice Address - Country:US
Practice Address - Phone:920-215-1553
Practice Address - Fax:920-821-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100273444Medicaid
WI100028111Medicaid