Provider Demographics
NPI:1659544849
Name:NORTHLAND COUNSELLING SERVICES LTD
Entity Type:Organization
Organization Name:NORTHLAND COUNSELLING SERVICES LTD
Other - Org Name:NORTHLAND COMMUNITY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW
Authorized Official - Phone:715-634-2522
Mailing Address - Street 1:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-1062
Mailing Address - Country:US
Mailing Address - Phone:715-634-2522
Mailing Address - Fax:715-634-2533
Practice Address - Street 1:10270 OLKER RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-2650
Practice Address - Country:US
Practice Address - Phone:715-634-2522
Practice Address - Fax:715-634-2533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHLAND COUNSELING SERVICES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2330251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43430500Medicaid