Provider Demographics
NPI:1962651646
Name:AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT AND SERVICES, INC.
Entity Type:Organization
Organization Name:AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT AND SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-532-9771
Mailing Address - Street 1:N4851 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-8675
Mailing Address - Country:US
Mailing Address - Phone:715-635-4858
Mailing Address - Fax:715-635-4861
Practice Address - Street 1:N4851 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-8675
Practice Address - Country:US
Practice Address - Phone:715-635-4858
Practice Address - Fax:715-635-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2631104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42244400Medicaid