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General NPI Number Information
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NPI Number | 1841514916
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Entity Type | Organization
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Legal Business Name | BELL THERAPY ASSOCIATES
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 5500 8TH AVE
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City | KENOSHA
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State | WI
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Zip | 53140-3700
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Country | US
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Telephone | 262-564-0067
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Fax | 262-652-1411
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Provider Business Mailing Address
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Address Line | 5500 8TH AVE
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City | KENOSHA
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State | WI
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Zip | 53140-3700
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Country | US
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Telephone | 262-564-0067
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Fax | 262-652-1411
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | RONALD MENDYKE
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Credential | MSW, LCSW
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Telephone | 414-527-6940
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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 | 1102
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License Number State | WI
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