Provider Demographics
NPI:1851066518
Name:PATCHWORK COUNSELING COLLECTIVE
Entity Type:Organization
Organization Name:PATCHWORK COUNSELING COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-470-5811
Mailing Address - Street 1:12425 KNOLL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2656
Mailing Address - Country:US
Mailing Address - Phone:414-775-8107
Mailing Address - Fax:
Practice Address - Street 1:12425 KNOLL RD STE 110
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2656
Practice Address - Country:US
Practice Address - Phone:414-775-8107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)