Provider Demographics
NPI:1760524854
Name:COUNSELING & DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:COUNSELING & DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-339-3048
Mailing Address - Street 1:171 CHESTNUT ST
Mailing Address - Street 2:PO BOX 71
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-1313
Mailing Address - Country:US
Mailing Address - Phone:715-339-3048
Mailing Address - Fax:715-339-2436
Practice Address - Street 1:171 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1313
Practice Address - Country:US
Practice Address - Phone:715-339-3048
Practice Address - Fax:715-339-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42141300Medicaid
WI3931356642010OtherBLUE CROSS BLUE SHIEL
WI42141300Medicaid