Provider Demographics
NPI:1073832440
Name:FAMILY COUNSELING CLINIC OF STEVENS POINT LLC
Entity Type:Organization
Organization Name:FAMILY COUNSELING CLINIC OF STEVENS POINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:715-345-1965
Mailing Address - Street 1:1052 MAIN ST STE 203
Mailing Address - Street 2:P.O. BOX 445
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-2848
Mailing Address - Country:US
Mailing Address - Phone:715-345-1965
Mailing Address - Fax:715-254-0372
Practice Address - Street 1:1052 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2848
Practice Address - Country:US
Practice Address - Phone:715-345-1965
Practice Address - Fax:715-254-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1320251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health