Provider Demographics
NPI:1225441298
Name:BAETEN COUNSELING & CONSULTATION TEAM, S.C.
Entity Type:Organization
Organization Name:BAETEN COUNSELING & CONSULTATION TEAM, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BAETEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC,ICS
Authorized Official - Phone:920-217-3313
Mailing Address - Street 1:2920 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1594
Mailing Address - Country:US
Mailing Address - Phone:920-217-3313
Mailing Address - Fax:920-217-3313
Practice Address - Street 1:2920 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1594
Practice Address - Country:US
Practice Address - Phone:920-217-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7709-123251S00000X
WI2075-132251S00000X
WI15372-135251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI844160017Medicaid
WI844160017Medicare UPIN