Provider Demographics
NPI:1154448330
Name:LUTHERAN COUNSELING & FAMILY SERVICES
Entity Type:Organization
Organization Name:LUTHERAN COUNSELING & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:MESECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:414-536-8333
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:SUITE785
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1309
Mailing Address - Country:US
Mailing Address - Phone:414-258-5704
Mailing Address - Fax:414-258-8406
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE785
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-258-5704
Practice Address - Fax:414-258-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43556500Medicaid