Healthcare Provider Details

I. General information

NPI: 1841374691
Provider Name (Legal Business Name): CAMBRIDGE COUNSELING CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAST MAIN ST
CAMBRIDGE WI
53523-0548
US

IV. Provider business mailing address

PO BOX 548
CAMBRIDGE WI
53523-0548
US

V. Phone/Fax

Practice location:
  • Phone: 608-423-4700
  • Fax: 608-423-7751
Mailing address:
  • Phone: 608-423-4700
  • Fax: 608-423-7751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1122
License Number StateWI

VIII. Authorized Official

Name: MS. DEBORAH C SULLIVAN
Title or Position: CLINIC DIRECTOR
Credential: LCSW
Phone: 608-423-4700