Provider Demographics
NPI:1588818892
Name:BUILDING BLOCKS FAMILY THERAPY CENTER,LLC
Entity type:Organization
Organization Name:BUILDING BLOCKS FAMILY THERAPY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:SENOGLES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:920-639-3907
Mailing Address - Street 1:522 GEORGE ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:DEPERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-639-3907
Mailing Address - Fax:
Practice Address - Street 1:522 GEORGE ST.
Practice Address - Street 2:SUITE B
Practice Address - City:DEPERE
Practice Address - State:WI
Practice Address - Zip Code:54115
Practice Address - Country:US
Practice Address - Phone:920-639-3907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6655-123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health