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NPI Code Detail

MEDICARE: INNOVATIVE COUNSELING INC

MEDICARE: INNOVATIVE COUNSELING INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency2283WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093869588
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNOVATIVE COUNSELING INC
Provider Business Mailing Address
First Line : 1499 6TH ST
Second Line : INNOVATIVE COUNSELING INC
City : GREEN BAY
State : WI
Zip : 54304-2252
Country : US
Telephone Number : 920-497-6161
Fax Number : 920-498-0476
Provider Business Practice Location Address
First Line : 1499 6TH ST
Second Line : INNOVATIVE COUNSELING INC
City : GREEN BAY
State : WI
Zip : 54304-2252
Country : US
Telephone Number : 920-497-6161
Fax Number : 920-498-0476
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MS. CYNTHIA RAE THOMAS
Credential : MSW ACSW
Telephone Number : 920-497-6161
Provider Enumeration Date : 01/22/2007
Last Update Date : 03/15/2010

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1013196062 — MR. CHRISTOPHER ANTHONY BUCKMAN MA
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Practice Fax: 920-498-0476

Directions to “INNOVATIVE COUNSELING INC ” Practice Location

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