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General NPI Number Information
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NPI Number | 1205825130
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Entity Type | Organization
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Legal Business Name | ONEIDA NATION
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 2640 W POINT RD
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City | GREEN BAY
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State | WI
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Zip | 54304-1344
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Country | US
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Telephone | 920-490-3790
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Fax | 920-490-3737
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Provider Business Mailing Address
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Address Line | PO BOX 365
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City | ONEIDA
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State | WI
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Zip | 54155-0365
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Country | US
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Telephone | 920-490-3790
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Fax | 920-490-3883
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH MANAGER
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Name | MARI KRIESCHER
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Credential | MS LPC CSAC ICS
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Telephone | 920-490-3790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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