Provider Demographics
NPI:1609950625
Name:FAMILY PARTNERS LLP - MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:FAMILY PARTNERS LLP - MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:715-369-6955
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-0742
Mailing Address - Country:US
Mailing Address - Phone:715-369-6955
Mailing Address - Fax:715-369-0581
Practice Address - Street 1:17A W DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3456
Practice Address - Country:US
Practice Address - Phone:715-369-6955
Practice Address - Fax:715-369-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42239400251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42239400Medicaid