Provider Demographics
NPI:1760854186
Name:GENESIS COUNSELING MINISTRIES LLC
Entity Type:Organization
Organization Name:GENESIS COUNSELING MINISTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEFEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-209-9194
Mailing Address - Street 1:N2338 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9210
Mailing Address - Country:US
Mailing Address - Phone:920-209-9194
Mailing Address - Fax:920-345-7887
Practice Address - Street 1:821 E 1ST AVE STE 2B
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1586
Practice Address - Country:US
Practice Address - Phone:920-209-9194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-25
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4315125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1386875755Medicaid