Provider Demographics
NPI:1255860912
Name:APPLETON COUNSELING MANAGEMENT LLC
Entity Type:Organization
Organization Name:APPLETON COUNSELING MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-281-0612
Mailing Address - Street 1:477 S NICOLET RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8270
Mailing Address - Country:US
Mailing Address - Phone:920-882-6610
Mailing Address - Fax:920-882-6611
Practice Address - Street 1:477 S NICOLET RD.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914
Practice Address - Country:US
Practice Address - Phone:920-882-6610
Practice Address - Fax:920-882-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========Medicaid