Provider Demographics
NPI:1275650673
Name:NEW WELLNESS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NEW WELLNESS ASSOCIATES, INC.
Other - Org Name:NEW WELLNESS ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-497-6200
Mailing Address - Street 1:2733 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5513
Mailing Address - Country:US
Mailing Address - Phone:920-497-6200
Mailing Address - Fax:920-497-3135
Practice Address - Street 1:2733 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5513
Practice Address - Country:US
Practice Address - Phone:920-497-6200
Practice Address - Fax:920-497-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42174300Medicaid