Provider Demographics
NPI:1659977866
Name:NYSTROM & ASSOCIATES COUNSELING WI., S.C.
Entity Type:Organization
Organization Name:NYSTROM & ASSOCIATES COUNSELING WI., S.C.
Other - Org Name:NYSTROM & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-628-9566
Mailing Address - Street 1:1900 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:651-379-1750
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:STE 500
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:651-379-1750
Practice Address - Fax:651-628-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)