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General NPI Number Information
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NPI Number | 1629244082
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Entity Type | Organization
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Legal Business Name | AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT AND SERVICES, INC.
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 24670 STATE ROAD 35 70 SUITE 1200
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City | SIREN
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State | WI
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Zip | 54872-4418
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Country | US
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Telephone | 715-349-7233
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Fax | 715-349-7205
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Provider Business Mailing Address
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Address Line | 24670 STATE ROAD 35 70 SUITE 1200
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City | SIREN
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State | WI
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Zip | 54872-4418
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Country | US
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Telephone | 715-349-7233
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Fax | 715-349-7205
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | KELLY JOHNSON
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Credential |
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Telephone | 715-532-9771
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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 | 2632
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License Number State | WI
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