Provider Demographics
NPI:1922126721
Name:ICHTHUS COUNSELING, LLC
Entity Type:Organization
Organization Name:ICHTHUS COUNSELING, LLC
Other - Org Name:JOHN R BRIGGS, PHD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-478-0032
Mailing Address - Street 1:11124 N CEDARBURG RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-4361
Mailing Address - Country:US
Mailing Address - Phone:262-478-0032
Mailing Address - Fax:262-478-0082
Practice Address - Street 1:11124 N CEDARBURG RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-4361
Practice Address - Country:US
Practice Address - Phone:262-478-0032
Practice Address - Fax:262-478-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2591251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39128000Medicaid