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General NPI Number Information
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NPI Number | 1801308218
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Entity Type | Organization
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Legal Business Name | NORTHWEST COUNSELING & GUIDANCE CLINIC, INC.
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 221 FIFTH STREET
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City | EAGLE RIVER
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State | WI
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Zip | 54521
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Country | US
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Telephone | 715-365-9735
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Fax | 888-226-8713
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | SIREN
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State | WI
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Zip | 54872-0309
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Country | US
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Telephone | 715-327-7112
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Fax | 888-625-8634
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Authorized Official
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Title or Position | CFO
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Name | JUSTIN COVEAU
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Credential |
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Telephone | 715-327-7112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | WI
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