Provider Demographics
NPI:1164808796
Name:MADISON BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:MADISON BEHAVIORAL SERVICES, LLC
Other - Org Name:MADISON BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:KIMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-514-1672
Mailing Address - Street 1:16 N CARROLL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2762
Mailing Address - Country:US
Mailing Address - Phone:608-514-1672
Mailing Address - Fax:608-401-4428
Practice Address - Street 1:16 N CARROLL ST
Practice Address - Street 2:STE 400
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2762
Practice Address - Country:US
Practice Address - Phone:608-514-1672
Practice Address - Fax:608-401-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095265Medicaid