Healthcare Provider Details

I. General information

NPI: 1609890391
Provider Name (Legal Business Name): RED OAK COUNSELING, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/22/2023
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12970 W BLUEMOUND RD SUITE 308
ELM GROVE WI
53122-2607
US

IV. Provider business mailing address

12970 W BLUEMOUND RD SUITE 308
ELM GROVE WI
53122-2607
US

V. Phone/Fax

Practice location:
  • Phone: 262-780-1020
  • Fax: 262-780-1022
Mailing address:
  • Phone: 262-780-1020
  • Fax: 262-780-1022

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 State

VIII. Authorized Official

Name: STACY CLOYD
Title or Position: SECRETARY
Credential:
Phone: 904-605-4986