LAKE GENEVA WELLNESS CLINIC LLC
NPI 1003845181
Psychologist - Clinical in Lake Geneva, WI

Q: What is Lake Geneva Wellness Clinic LLC's NPI number?

The NPI number for Lake Geneva Wellness Clinic LLC is 1003845181. It was assigned to this organization in the NPPES registry on July 1, 2006.

Q: What is Lake Geneva Wellness Clinic LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since July 01, 2006

750 VETERANS PKWY UNIT 100, LAKE GENEVA, WI 53147(262) 248-7942(262) 248-1202 Get Directions Write a Review

NPPES record last updated: September 12, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 12, 2024, Mar 25, 2021 (2 updates tracked since 2021).

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About Lake Geneva Wellness Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE GENEVA WELLNESS CLINIC LLC (NPI 1003845181) is a healthcare organization registered as a clinical in Lake Geneva, Wisconsin and active in the NPI registry since July 2006. The organization lists Erika K Fountain, Owner, as its authorized official.

NPPES Registry Identity

NPI1003845181

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameLAKE GENEVA WELLNESS CLINIC LLC

Location Address750 VETERANS PKWY UNIT 100Lake Geneva, WI 53147-4950

Mailing Address750 Veterans Pkwy Unit 100Lake Geneva, WI 53147-4950 · (262) 248-7942 · Fax (262) 248-1202

Phone(262) 248-7942

Fax(262) 248-1202

Organization SubpartNo

Authorized OfficialErika K FountainOwner · (262) 248-7942

Enumeration DateJuly 1, 2006

Last NPPES UpdateSeptember 12, 20242 updates tracked since enumeration

NPPES CertifiedSeptember 12, 2024

✔ NPI 1003845181 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in WI · 811-057

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

750 VETERANS PKWY UNIT 100, Lake Geneva, WI 53147

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Other Identifiers 1

Medicaid42126800WI

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, HealthPartners, Quartz.Insurance ›

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATTHEW BANAS

Counselor (Mental Health)