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General NPI Number Information
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NPI Number | 1275650673
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Entity Type | Organization
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Legal Business Name | NEW WELLNESS ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 2733 S RIDGE RD
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City | GREEN BAY
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State | WI
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Zip | 54304-5513
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Country | US
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Telephone | 920-497-6200
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Fax | 920-497-3135
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Provider Business Mailing Address
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Address Line | 2733 S RIDGE RD
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City | GREEN BAY
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State | WI
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Zip | 54304-5513
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Country | US
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Telephone | 920-497-6200
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Fax | 920-497-3135
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOANN M BERKEN
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Credential |
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Telephone | 920-497-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1669
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License Number State | WI
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