Provider Demographics
NPI:1346466562
Name:CENTER FOR EFFECTIVE LIVING
Entity Type:Organization
Organization Name:CENTER FOR EFFECTIVE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAJEUNESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:608-782-5775
Mailing Address - Street 1:603 KING ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4140
Mailing Address - Country:US
Mailing Address - Phone:608-782-5775
Mailing Address - Fax:608-782-5608
Practice Address - Street 1:603 KING ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4140
Practice Address - Country:US
Practice Address - Phone:608-782-5775
Practice Address - Fax:608-782-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1151261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)