Provider Demographics
NPI:1619225232
Name:CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC
Entity Type:Organization
Organization Name:CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC
Other - Org Name:EMPOWER MENTAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANTONIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-327-7015
Mailing Address - Street 1:2001 S CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4973
Mailing Address - Country:US
Mailing Address - Phone:715-384-2818
Mailing Address - Fax:715-384-2724
Practice Address - Street 1:2001 S CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4973
Practice Address - Country:US
Practice Address - Phone:715-384-2818
Practice Address - Fax:715-384-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health