Provider Demographics
NPI:1508565342
Name:SHANTI COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:SHANTI COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KLEPPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:262-212-2764
Mailing Address - Street 1:405 E FOREST ST
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3707
Mailing Address - Country:US
Mailing Address - Phone:262-955-1079
Mailing Address - Fax:262-205-7089
Practice Address - Street 1:405 E FOREST ST
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3707
Practice Address - Country:US
Practice Address - Phone:262-955-1079
Practice Address - Fax:262-205-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100180598Medicaid