Provider Demographics
NPI:1336298553
Name:NORTHWEST COUNSELING SERVICES, S.C.
Entity Type:Organization
Organization Name:NORTHWEST COUNSELING SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-246-7777
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:240 WISCONSIN DRIVE, SUITE 104
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-0087
Mailing Address - Country:US
Mailing Address - Phone:715-246-7777
Mailing Address - Fax:715-246-7775
Practice Address - Street 1:240 WISCONSIN DR STE 104
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-2611
Practice Address - Country:US
Practice Address - Phone:715-246-7777
Practice Address - Fax:715-246-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1702101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI88277Medicare ID - Type Unspecified