Provider Demographics
NPI:1639402902
Name:INNERVISIONS COUNSELING & CONSULTING CENTER, S.C.
Entity Type:Organization
Organization Name:INNERVISIONS COUNSELING & CONSULTING CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:SUZANNA
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCSW, CSAC
Authorized Official - Phone:608-477-9858
Mailing Address - Street 1:840 STATE ROAD 136 STE 1
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9252
Mailing Address - Country:US
Mailing Address - Phone:608-477-9858
Mailing Address - Fax:877-560-0578
Practice Address - Street 1:840 STATE ROAD 136 STE 1
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9252
Practice Address - Country:US
Practice Address - Phone:608-477-9858
Practice Address - Fax:877-560-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133101YA0400X
WI#2101YP2500X
WI#1231041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39602100Medicaid
WI39602100Medicaid