Provider Demographics
NPI:1750460929
Name:MENTAL HEALTH PARTNERS, SC
Entity Type:Organization
Organization Name:MENTAL HEALTH PARTNERS, SC
Other - Org Name:MARRIAGE & FAMILY THERAPY CENTER, SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-632-7040
Mailing Address - Street 1:3000 RIVERSIDE DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1653
Mailing Address - Country:US
Mailing Address - Phone:920-632-7040
Mailing Address - Fax:920-632-7262
Practice Address - Street 1:3000 RIVERSIDE DR
Practice Address - Street 2:SUITE 180
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1653
Practice Address - Country:US
Practice Address - Phone:920-632-7040
Practice Address - Fax:920-632-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========012OtherBCBS
WI000007860Medicare PIN