Provider Demographics
NPI:1952665044
Name:RESPECT COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:RESPECT COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BLU
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALLIES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:920-230-2207
Mailing Address - Street 1:302 STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4847
Mailing Address - Country:US
Mailing Address - Phone:920-230-2207
Mailing Address - Fax:920-230-2208
Practice Address - Street 1:302 STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4847
Practice Address - Country:US
Practice Address - Phone:920-230-2207
Practice Address - Fax:920-230-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI803-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty