Provider Demographics
NPI:1629328067
Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICES
Entity Type:Organization
Organization Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICES
Other - Org Name:CHRISTIAN FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-345-5533
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:262-345-5560
Mailing Address - Fax:262-345-5531
Practice Address - Street 1:1660 HASLETT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8469
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-345-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI819-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty