Provider Demographics
NPI:1134379704
Name:NORTHLAND COUNSELING SERVICES LTD
Entity type:Organization
Organization Name:NORTHLAND COUNSELING SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW
Authorized Official - Phone:715-373-0160
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-0765
Mailing Address - Country:US
Mailing Address - Phone:715-373-0160
Mailing Address - Fax:
Practice Address - Street 1:1619 WEST 3RD ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1114
Practice Address - Country:US
Practice Address - Phone:715-373-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2639251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32979600Medicaid