Provider Demographics
NPI:1841429073
Name:BAY COUNSELING CLINIC, LLP
Entity Type:Organization
Organization Name:BAY COUNSELING CLINIC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAHL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-743-6522
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-0321
Mailing Address - Country:US
Mailing Address - Phone:920-743-4428
Mailing Address - Fax:920-743-4681
Practice Address - Street 1:50 S MADISON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2742
Practice Address - Country:US
Practice Address - Phone:920-743-4428
Practice Address - Fax:920-743-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2871251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health