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General NPI Number Information
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NPI Number | 1821281577
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Entity Type | Organization
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Legal Business Name | COULEE YOUTH CENTERS, INC.
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 231 COPELAND AVE
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City | LA CROSSE
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State | WI
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Zip | 54603-3086
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Country | US
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Telephone | 608-782-7152
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Fax | 608-785-1241
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Provider Business Mailing Address
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Address Line | 231 COPELAND AVE P.O.BOX 1836
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City | LA CROSSE
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State | WI
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Zip | 54603-3086
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Country | US
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Telephone | 608-782-7152
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Fax | 608-785-1241
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. STEVEN T. EIDE
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Credential | CSW
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Telephone | 608-782-7152
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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 | 1241
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License Number State | WI
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