Provider Demographics
NPI:1033440227
Name:ALLEMAGNE COUNSELING & CONSULTATION SERVICES,
Entity Type:Organization
Organization Name:ALLEMAGNE COUNSELING & CONSULTATION SERVICES,
Other - Org Name:THE EMDR CENTER FOR RELATIONSHIPS & HEALING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEMAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-325-9500
Mailing Address - Street 1:2916 MARKETPLACE DRIVE
Mailing Address - Street 2:SUITE # 212
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5327
Mailing Address - Country:US
Mailing Address - Phone:608-325-9500
Mailing Address - Fax:888-345-6310
Practice Address - Street 1:2916 MARKETPLACE DRIVE
Practice Address - Street 2:SUITE # 212
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-5327
Practice Address - Country:US
Practice Address - Phone:608-325-9500
Practice Address - Fax:888-345-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI761124103TC1900X
IL166000551103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI761124OtherWISCONSIN LICENSE
IL166000551OtherIL LICENSE