MEDICARE: AADVANTAGE BEHAVIORAL HEALTHCARE, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	2498	WI
2	261QM0850X	Adult Mental Health Clinic/Center	6647-123	WI
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center	6647-123	WI
4	1041C0700X	Clinical Social Worker	6647-123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669602488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AADVANTAGE BEHAVIORAL HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	N6658 WOODFIELD LN
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-9740
Country	:	US
Telephone Number	:	608-843-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 E PINE ST
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-1103
Country	:	US
Telephone Number	:	608-843-4555
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MAUREEN GALE BUSS
Credential	:
Telephone Number	:	608-843-4555

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/15/2009

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Directions to “AADVANTAGE BEHAVIORAL HEALTHCARE, LLC ” Practice Location

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