Provider Demographics
NPI:1801043385
Name:WASHINGTON COUNTY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:WASHINGTON COUNTY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STRACHOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-335-4545
Mailing Address - Street 1:333 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2585
Mailing Address - Country:US
Mailing Address - Phone:262-335-4545
Mailing Address - Fax:262-335-6827
Practice Address - Street 1:333 E WASHINGTON ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2585
Practice Address - Country:US
Practice Address - Phone:262-335-4545
Practice Address - Fax:262-335-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2580251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41760200Medicaid