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General NPI Number Information
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NPI Number | 1467453167
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Entity Type | Organization
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Legal Business Name | FAMILY SERVICES OF NORTHEAST WISCONSIN INC
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 300 CROOKS ST
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City | GREEN BAY
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State | WI
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Zip | 54301-4527
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Country | US
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Telephone | 920-436-6800
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Fax | 920-437-3540
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Provider Business Mailing Address
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Address Line | PO BOX 22308
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City | GREEN BAY
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State | WI
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Zip | 54305-2308
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Country | US
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Telephone | 920-436-6800
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Fax | 920-437-3540
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. LOIS MISCHLER
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Credential | LCSW
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Telephone | 920-436-6800
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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 | 1329
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License Number State | WI
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