Provider Demographics
NPI:1801387329
Name:PFISTER, THOMAS NATHANIEL (LPC, CSAC, NCC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:NATHANIEL
Last Name:PFISTER
Suffix:
Gender:M
Credentials:LPC, CSAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2316
Mailing Address - Country:US
Mailing Address - Phone:920-272-8234
Mailing Address - Fax:651-323-2648
Practice Address - Street 1:1475 OPPORTUNITY WAY
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1293
Practice Address - Country:US
Practice Address - Phone:920-272-8234
Practice Address - Fax:651-323-2648
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7511-125101YM0800X, 101YP2500X
WI16389-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1092317OtherNCC CERTIFICATION
1013375104OtherAGENCY NPI NUMBER
14264776OtherCAQH
WI100077603Medicaid