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General NPI Number Information
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NPI Number | 1043588254
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Entity Type | Organization
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Legal Business Name | GENESIS BEHAVIORAL SERVICES, INC
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 1626 CLARENCE CT
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City | WEST BEND
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State | WI
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Zip | 53095-8533
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Country | US
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Telephone | 262-338-8611
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Fax | 262-338-3367
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Provider Business Mailing Address
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Address Line | 1626 CLARENCE CT
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City | WEST BEND
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State | WI
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Zip | 53095-8533
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Country | US
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Telephone | 262-338-8611
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Fax | 262-338-3367
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. KIMBERLY A KUNZ
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Credential | MA,LPC,NCC,CSAC,ICS
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Telephone | 262-338-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 16431 - 130
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16431 - 130
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License Number State | WI
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