=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114190485
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBIA COUNTY HHSD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2008
-----------------------------------------------------
Last Update Date | 05/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 E MULLETT ST
-----------------------------------------------------
City | PORTAGE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53901-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-742-9227
-----------------------------------------------------
Fax | 608-742-9700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2652 MURPHY RD P.O. BOX 136
-----------------------------------------------------
City | PORTAGE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53901-1094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-742-9227
-----------------------------------------------------
Fax | 608-742-9700
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | HEATHER J GOVE
-----------------------------------------------------
Credential | CSW, LPC
-----------------------------------------------------
Telephone | 608-742-9215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------