Healthcare Provider Details

I. General information

NPI: 1750460929
Provider Name (Legal Business Name): MENTAL HEALTH PARTNERS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 RIVERSIDE DR SUITE 180
GREEN BAY WI
54301-1653
US

IV. Provider business mailing address

3000 RIVERSIDE DR SUITE 180
GREEN BAY WI
54301-1653
US

V. Phone/Fax

Practice location:
  • Phone: 920-632-7040
  • Fax: 920-632-7262
Mailing address:
  • Phone: 920-632-7040
  • Fax: 920-632-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM L SLAMP
Title or Position: OFFICE MANAGER
Credential:
Phone: 920-632-7040