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NPI Code Detail

MEDICARE: MARRIAGE & FAMILY HEALTH SERVICE, LTD

MEDICARE: MARRIAGE & FAMILY HEALTH SERVICE, LTD
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
1101YM0800XMental Health CounselorWI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1223799OTHERWIMHN/TRICARE INS. CO.
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912173519
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARRIAGE & FAMILY HEALTH SERVICE, LTD
Provider Business Mailing Address
First Line : 2925 MONDOVI RD
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-6141
Country : US
Telephone Number : 715-832-0238
Fax Number : 715-832-0771
Provider Business Practice Location Address
First Line : 1107 HEART ISLAND PKWY
Second Line :
City : RICE LAKE
State : WI
Zip : 54868-3900
Country : US
Telephone Number : 715-832-0238
Fax Number : 715-832-0771
Authorized Official
Title or Position : DIRECTOR/OWNER
Name : DR. THOMAS E JOHNSTON
Credential : PHD
Telephone Number : 715-832-0238
Provider Enumeration Date : 05/02/2008
Last Update Date : 05/02/2008

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