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General NPI Number Information
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NPI Number | 1356885339
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Entity Type | Organization
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Legal Business Name | NORTHWOODS BEHAVIORAL HEALTH SERVICES, LLC.
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 15617 US HIGHWAY 63
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City | HAYWARD
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State | WI
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Zip | 54843-4244
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Country | US
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Telephone | 715-634-4673
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Fax | 715-634-4675
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Provider Business Mailing Address
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Address Line | 15617 US HIGHWAY 63 P.O. BOX 800
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City | HAYWARD
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State | WI
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Zip | 54843-4244
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Country | US
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Telephone | 715-634-4673
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Fax | 715-634-4675
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Authorized Official
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Title or Position | DIRECTOR - THERAPIST
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Name | MR. DANIEL DEAN COUSINS SR.
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Credential | MSW, CSAC, IDP-AT
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Telephone | 715-634-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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