Provider Demographics
NPI:1073719548
Name:BELL THERAPY INC CSP SOUTH
Entity Type:Organization
Organization Name:BELL THERAPY INC CSP SOUTH
Other - Org Name:CSP SOUTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-871-6122
Mailing Address - Street 1:634 W HISTORIC MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-3512
Mailing Address - Country:US
Mailing Address - Phone:414-383-4486
Mailing Address - Fax:
Practice Address - Street 1:634 W HISTORIC MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3512
Practice Address - Country:US
Practice Address - Phone:414-383-4486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1095251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43428800Medicaid
WI1095OtherSTATE CERTIFICATE-LICENSE