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General NPI Number Information
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NPI Number | 1598080525
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL SERVICES GROUP, INC.
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 220 WASHINGTON AVENUE
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City | OSHKOSH
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State | WI
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Zip | 54903
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Country | US
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Telephone | 920-237-6990
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Fax | 920-424-7521
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Provider Business Mailing Address
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Address Line | 1126 S. 70TH STREET SUITE S-507
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City | WEST ALLIS
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State | WI
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Zip | 53214-3151
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Country | US
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Telephone | 414-727-2789
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Fax | 414-476-8695
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | BRIAN A WOLF
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Credential | PHD
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Telephone | 414-727-2789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1749
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License Number State | WI
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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 | 1749
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License Number State | WI
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