Provider Demographics
NPI:1346409018
Name:ACT XII COUNSELING AND MINISTRY, INC
Entity Type:Organization
Organization Name:ACT XII COUNSELING AND MINISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-459-8866
Mailing Address - Street 1:4023 N 47TH PL
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-2554
Mailing Address - Country:US
Mailing Address - Phone:920-459-8866
Mailing Address - Fax:920-459-8866
Practice Address - Street 1:4023 N 47TH PL
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-2554
Practice Address - Country:US
Practice Address - Phone:920-459-8866
Practice Address - Fax:920-459-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIL025526103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty