Provider Demographics
NPI:1982000154
Name:WING OF EAGLES CORP
Entity Type:Organization
Organization Name:WING OF EAGLES CORP
Other - Org Name:WINGS OF EAGLES COUNSELING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:920-228-3199
Mailing Address - Street 1:217 N MADISON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-5103
Mailing Address - Country:US
Mailing Address - Phone:920-227-7078
Mailing Address - Fax:920-273-8847
Practice Address - Street 1:217 N MADISON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-5103
Practice Address - Country:US
Practice Address - Phone:920-227-7078
Practice Address - Fax:920-273-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty