Healthcare Provider Details

I. General information

NPI: 1619813136
Provider Name (Legal Business Name): OFF-THE-TRACK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7802 QUIGLEY RD
OMRO WI
54963-9368
US

IV. Provider business mailing address

222 MADISON AVE
OMRO WI
54963-1459
US

V. Phone/Fax

Practice location:
  • Phone: 920-500-0596
  • Fax:
Mailing address:
  • Phone: 920-427-2598
  • Fax:

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: JORDAN KAURIN
Title or Position: OWNER
Credential: LPC
Phone: 920-500-0596