Provider Demographics
NPI:1922014414
Name:COUNSELING ASSOCIATES OF MADISON, S.C.
Entity Type:Organization
Organization Name:COUNSELING ASSOCIATES OF MADISON, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:VERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-233-3000
Mailing Address - Street 1:715 HILL STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3517
Mailing Address - Country:US
Mailing Address - Phone:608-233-3000
Mailing Address - Fax:608-233-3834
Practice Address - Street 1:715 HILL STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3517
Practice Address - Country:US
Practice Address - Phone:608-233-3000
Practice Address - Fax:608-233-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1251261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI84268Medicare ID - Type Unspecified