Healthcare Provider Details

I. General information

NPI: 1003311556
Provider Name (Legal Business Name): BE CHILD AND ADOLESCENT MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 04/18/2024
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S ONEIDA ST
APPLETON WI
54915-1351
US

IV. Provider business mailing address

1309 S ONEIDA ST
APPLETON WI
54915-1351
US

V. Phone/Fax

Practice location:
  • Phone: 920-903-8841
  • Fax:
Mailing address:
  • Phone: 920-903-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number3407-57
License Number StateWI

VIII. Authorized Official

Name: DR. CAREY SORENSON
Title or Position: OWNER
Credential: PHD
Phone: 920-903-8841