Provider Demographics
NPI:1851838205
Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICE ,INC.
Entity Type:Organization
Organization Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICE ,INC.
Other - Org Name:CHRISTIAN FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KLUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-985-9522
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:800-438-1772
Mailing Address - Fax:262-345-5562
Practice Address - Street 1:7979 HOLDREGE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-3036
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-293-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty