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General NPI Number Information
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NPI Number | 1467419200
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Entity Type | Organization
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Legal Business Name | FAMILY SERVICE OF RACINE
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 420 7TH STREET
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City | RACINE
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State | WI
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Zip | 53403-1222
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Country | US
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Telephone | 262-634-2391
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Fax | 262-634-5342
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Provider Business Mailing Address
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Address Line | 420 7TH STREET
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City | RACINE
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State | WI
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Zip | 53403-1222
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Country | US
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Telephone | 262-634-2391
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Fax | 262-634-5342
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KATIE L. OATSVALL
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Credential |
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Telephone | 262-634-2391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1339
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License Number State | WI
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