Healthcare Provider Details

I. General information

NPI: 1336298553
Provider Name (Legal Business Name): NORTHWEST COUNSELING SERVICES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WISCONSIN DR STE 104 SUITE 104
NEW RICHMOND WI
54017-2611
US

IV. Provider business mailing address

PO BOX 87 240 WISCONSIN DRIVE, SUITE 104
NEW RICHMOND WI
54017-0087
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-7777
  • Fax: 715-246-7775
Mailing address:
  • Phone: 715-246-7777
  • Fax: 715-246-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1702
License Number StateWI

VIII. Authorized Official

Name: MS. PEGGY AUDLEY
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 715-246-7777