Healthcare Provider Details

I. General information

NPI: 1801335377
Provider Name (Legal Business Name): ATTENTIVE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E GRAND AVE
BELOIT WI
53511-6200
US

IV. Provider business mailing address

400 E GRAND AVE
BELOIT WI
53511-6200
US

V. Phone/Fax

Practice location:
  • Phone: 608-322-4410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6361-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6361-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6361-125
License Number StateWI

VIII. Authorized Official

Name: ROBERT SCHUH
Title or Position: OWNER
Credential: LPC
Phone: 608-322-4410