Provider Demographics
NPI:1881828846
Name:COULEE REGION PSYCHIATRIC SERVICES, S.C.
Entity Type:Organization
Organization Name:COULEE REGION PSYCHIATRIC SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRANNEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-797-6284
Mailing Address - Street 1:1309 3RD AVE. N.
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-9130
Mailing Address - Country:US
Mailing Address - Phone:608-797-6284
Mailing Address - Fax:
Practice Address - Street 1:3626 EAST AVE. SO.
Practice Address - Street 2:SUITE 2A
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7211
Practice Address - Country:US
Practice Address - Phone:608-788-1114
Practice Address - Fax:608-788-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37852-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty