Provider Demographics
NPI:1609814367
Name:CEDAR CREEK FAMILY COUNSELING, INC
Entity Type:Organization
Organization Name:CEDAR CREEK FAMILY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BUCKLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC III
Authorized Official - Phone:414-427-4884
Mailing Address - Street 1:9910 W. LAYTON AVE.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228
Mailing Address - Country:US
Mailing Address - Phone:414-427-4884
Mailing Address - Fax:414-427-4889
Practice Address - Street 1:9910 W. LAYTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228
Practice Address - Country:US
Practice Address - Phone:414-427-4884
Practice Address - Fax:414-427-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42188500Medicaid