Provider Demographics
NPI:1821141540
Name:PSYCHIATRIC ASSOCIATES COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-637-2511
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:122 W SOUTH ST
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-0206
Mailing Address - Country:US
Mailing Address - Phone:608-637-2511
Mailing Address - Fax:608-637-7921
Practice Address - Street 1:122 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-0206
Practice Address - Country:US
Practice Address - Phone:608-637-2511
Practice Address - Fax:608-637-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1754261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42167000Medicaid
WI42167000Medicaid