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General NPI Number Information
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NPI Number | 1225441298
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Entity Type | Organization
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Legal Business Name | BAETEN COUNSELING & CONSULTATION TEAM, S.C.
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Dates
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Enumeration Date | 06/08/2014
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Last Update Date | 06/08/2014
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Provider Practice Location Address
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Address Line | 2920 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-1594
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Country | US
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Telephone | 920-217-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 2920 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-1594
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Country | US
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Telephone | 920-217-3313
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Fax | 920-217-3313
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | TINA MARIE BAETEN
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Credential | LCSW, CSAC,ICS
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Telephone | 920-217-3313
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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 | 2075-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 15372-135
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 7709-123
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License Number State | WI
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