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General NPI Number Information
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NPI Number | 1437336583
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Entity Type | Organization
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Legal Business Name | BAYSHORE COUNSELING NETWORK
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 2345 E MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54302-3764
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Country | US
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Telephone | 920-469-8890
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Fax | 920-406-3909
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Provider Business Mailing Address
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Address Line | 2345 E MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54302-3764
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Country | US
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Telephone | 920-469-8890
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Fax | 920-406-3909
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MARI C MARTIN
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Credential | MSE
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Telephone | 920-469-8890
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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 | 13018-020
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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 | 1951-125
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License Number State | WI
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