Healthcare Provider Details

I. General information

NPI: 1942594791
Provider Name (Legal Business Name): NORTHWEST COUNSELING AND GUIDANCE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7670 JOHNSON STREET
SIREN WI
54872-3993
US

IV. Provider business mailing address

7670 JOHNSON STREET
SIREN WI
54872-3993
US

V. Phone/Fax

Practice location:
  • Phone: 715-349-2829
  • Fax: 715-349-2737
Mailing address:
  • Phone: 715-349-2829
  • Fax: 715-349-2737

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: NICK KALAMBOKIDIS
Title or Position: CFO
Credential:
Phone: 715-327-4322