Provider Demographics
NPI:1225412075
Name:MADISON COUNSELING CENTER LLC.
Entity Type:Organization
Organization Name:MADISON COUNSELING CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC, CHT LMHC
Authorized Official - Phone:608-283-9291
Mailing Address - Street 1:1050 REGENT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1263
Mailing Address - Country:US
Mailing Address - Phone:608-283-9291
Mailing Address - Fax:608-237-2587
Practice Address - Street 1:1050 REGENT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1263
Practice Address - Country:US
Practice Address - Phone:608-283-9291
Practice Address - Fax:608-237-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4376-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100027479Medicaid