MEDICARE: ATTIC CORRECTIONAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	1184859936	WI

General Provider Information

NPI Number	:	1477873388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATTIC CORRECTIONAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1546
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54912-1546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 W WASHINGTON ST
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-3805
Country	:	US
Telephone Number	:	920-830-1750
Fax Number	:	920-830-1770

Authorized Official
Title or Position	:	SUBSTANCE ABUSE COUNSELOR
Name	:	MS. MARY K MORLOCK
Credential	:
Telephone Number	:	920-830-1750

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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Directions to “ATTIC CORRECTIONAL SERVICES ” Practice Location

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