=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477921773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TREMPEALEAU COUNTY HUMAN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2015
-----------------------------------------------------
Last Update Date | 09/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36245 MAIN ST
-----------------------------------------------------
City | WHITEHALL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54773-0067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-538-2311
-----------------------------------------------------
Fax | 715-538-4274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 67
-----------------------------------------------------
City | WHITEHALL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54773-0067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-538-2311
-----------------------------------------------------
Fax | 715-538-4274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DEB SUCHLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-538-2311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------