Healthcare Provider Details

I. General information

NPI: 1639402902
Provider Name (Legal Business Name): INNERVISIONS COUNSELING & CONSULTING CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 STATE ROAD 136 STE 1
BARABOO WI
53913-9252
US

IV. Provider business mailing address

840 STATE ROAD 136 STE 1
BARABOO WI
53913-9252
US

V. Phone/Fax

Practice location:
  • Phone: 608-477-9858
  • Fax: 877-560-0578
Mailing address:
  • Phone: 608-477-9858
  • Fax: 877-560-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number133
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#2
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number#123
License Number StateWI

VIII. Authorized Official

Name: MS. COLLEEN SUZANNA JAMES
Title or Position: DIRECTOR
Credential: LPC, LCSW, CSAC
Phone: 608-477-9858