Provider Demographics
NPI:1942594791
Name:NORTHWEST COUNSELING AND GUIDANCE CLINIC
Entity Type:Organization
Organization Name:NORTHWEST COUNSELING AND GUIDANCE CLINIC
Other - Org Name:NORTHWEST DIRECTIONS - SIREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAMBOKIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-327-4322
Mailing Address - Street 1:7670 JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-3993
Mailing Address - Country:US
Mailing Address - Phone:715-349-2829
Mailing Address - Fax:715-349-2737
Practice Address - Street 1:7670 JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-3993
Practice Address - Country:US
Practice Address - Phone:715-349-2829
Practice Address - Fax:715-349-2737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST COUNSELING AND GUIDANCE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)