Healthcare Provider Details

I. General information

NPI: 1457635492
Provider Name (Legal Business Name): CENTER POINT COUNSELING SERVICES COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 AIRPORT RD STE 103
VIROQUA WI
54665-1160
US

IV. Provider business mailing address

210 AIRPORT RD STE 103 PO BOX 189
VIROQUA WI
54665-1160
US

V. Phone/Fax

Practice location:
  • Phone: 608-638-7420
  • Fax:
Mailing address:
  • Phone: 608-638-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHERI HAMMOND
Title or Position: GENERAL MANAGER
Credential:
Phone: 608-638-7420