Provider Demographics
NPI:1689898272
Name:GENESIS COUNSELING GROUP, S.C.
Entity Type:Organization
Organization Name:GENESIS COUNSELING GROUP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-780-0991
Mailing Address - Street 1:890 ELM GROVE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2528
Mailing Address - Country:US
Mailing Address - Phone:262-780-0991
Mailing Address - Fax:262-780-0992
Practice Address - Street 1:890 ELM GROVE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2528
Practice Address - Country:US
Practice Address - Phone:262-780-0991
Practice Address - Fax:262-780-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty