Healthcare Provider Details

I. General information

NPI: 1104855279
Provider Name (Legal Business Name): ASSOCIATED COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N 3RD AVE SUITE A
WAUSAU WI
54401-2913
US

IV. Provider business mailing address

PO BOX 1721
WAUSAU WI
54402-1721
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-3031
  • Fax: 715-848-5008
Mailing address:
  • Phone: 715-848-3031
  • Fax: 715-848-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2503
License Number StateWI

VIII. Authorized Official

Name: MS. CAROL J WESLEY
Title or Position: CO-DIRECTOR
Credential: MS, LPC
Phone: 715-848-3031