Provider Demographics
NPI:1497828735
Name:LUTHERAN COUNSELING & FAMILY SERVICES
Entity Type:Organization
Organization Name:LUTHERAN COUNSELING & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:MESECK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:1414-536-8333
Mailing Address - Street 1:601 FALL ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3157
Mailing Address - Country:US
Mailing Address - Phone:715-524-4840
Mailing Address - Fax:715-524-4236
Practice Address - Street 1:601 FALL ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3157
Practice Address - Country:US
Practice Address - Phone:715-524-4840
Practice Address - Fax:715-524-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22111251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39214500Medicaid