Provider Demographics
NPI:1316012396
Name:CENTRAL WISCONSIN COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CENTRAL WISCONSIN COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:AURIL
Authorized Official - Last Name:SOE
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCSW
Authorized Official - Phone:715-424-6960
Mailing Address - Street 1:320 W GRAND AVE
Mailing Address - Street 2:SUITE 304A
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-2781
Mailing Address - Country:US
Mailing Address - Phone:715-424-6960
Mailing Address - Fax:715-424-6963
Practice Address - Street 1:320 W GRAND AVE
Practice Address - Street 2:SUITE 304A
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2781
Practice Address - Country:US
Practice Address - Phone:715-424-6960
Practice Address - Fax:715-424-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42224800Medicaid