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General NPI Number Information
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NPI Number | 1851838205
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Entity Type | Organization
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Legal Business Name | WISCONSIN LUTHERAN CHILD & FAMILY SERVICE ,INC.
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 7979 HOLDREGE ST
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City | LINCOLN
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State | NE
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Zip | 68505-3036
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Country | US
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Telephone | 800-438-1772
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Fax | 262-293-9737
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR
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City | GERMANTOWN
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State | WI
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Zip | 53022-6511
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Country | US
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Telephone | 800-438-1772
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Fax | 262-345-5562
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Authorized Official
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Title or Position | CEO
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Name | MARK KLUG
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Credential |
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Telephone | 888-985-9522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11017
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License Number State | NE
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