Provider Demographics
NPI:1891863494
Name:NORTH CENTRAL COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL COUNSELING CENTER, INC.
Other - Org Name:JOSEPH F. ROE, PSYD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, SAC, NCC
Authorized Official - Phone:715-678-2250
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:STETSONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54480-0105
Mailing Address - Country:US
Mailing Address - Phone:715-678-2250
Mailing Address - Fax:715-678-2662
Practice Address - Street 1:132 E COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:STETSONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54480-9587
Practice Address - Country:US
Practice Address - Phone:715-678-2250
Practice Address - Fax:715-678-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1563123OtherDEPT OF REGULATION & LIC
WI000088235Medicare PIN