Provider Demographics
NPI:1760881890
Name:CEDAR CREEK FAMILY COUNSELING INC
Entity Type:Organization
Organization Name:CEDAR CREEK FAMILY COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BUCKLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-427-4884
Mailing Address - Street 1:9910 W LAYTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3363
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9910 W LAYTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3363
Practice Address - Country:US
Practice Address - Phone:414-427-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17136-130324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility