Provider Demographics
NPI:1699015636
Name:MENTE SALUS PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:MENTE SALUS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:ALBANESE-KOTAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-839-7240
Mailing Address - Street 1:4319 JEFFERS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3726
Mailing Address - Country:US
Mailing Address - Phone:715-839-7240
Mailing Address - Fax:715-839-7674
Practice Address - Street 1:4319 JEFFERS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-3726
Practice Address - Country:US
Practice Address - Phone:715-839-7240
Practice Address - Fax:715-839-7674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2858-057103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700105855Medicaid
1700105855OtherNPI TYPE I