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NPI Code Detail

MEDICARE: SUPERIOR BEHAVIORAL SERVICES

MEDICARE: SUPERIOR BEHAVIORAL 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1508574351
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPERIOR BEHAVIORAL SERVICES
Provider Business Mailing Address
First Line : 5300 STINSON AVE
Second Line :
City : SUPERIOR
State : WI
Zip : 54880-6313
Country : US
Telephone Number : 218-216-7798
Fax Number :
Provider Business Practice Location Address
First Line : 5300 STINSON AVE
Second Line :
City : SUPERIOR
State : WI
Zip : 54880-6313
Country : US
Telephone Number : 218-216-7798
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ELISHA ZAVODNIK
Credential :
Telephone Number : 218-216-7798
Provider Enumeration Date : 11/10/2022
Last Update Date : 05/17/2023

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Directions to “SUPERIOR BEHAVIORAL SERVICES ” Practice Location

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