Provider Demographics
NPI:1912004516
Name:MADISON MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:MADISON MENTAL HEALTH SERVICES
Other - Org Name:SATELLITE OFFICE--715 HILL STREET, MADISON 53705
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGLOIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:608-231-2008
Mailing Address - Street 1:702 N BLACKHAWK AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3357
Mailing Address - Country:US
Mailing Address - Phone:608-238-5535
Mailing Address - Fax:608-238-7294
Practice Address - Street 1:715 HILL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3542
Practice Address - Country:US
Practice Address - Phone:608-238-5535
Practice Address - Fax:608-238-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-18
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty