LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN INC

Provider Demographics

• NPI: 1184703290
• Name: LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN INC
• Entity type: Organization
• Organization Name: LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN INC
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: DR
• Authorized Official - First Name: CHUCK
• Authorized Official - Last Name: MESECK
• Authorized Official - Credentials: PSYD
• Authorized Official - Phone: 414-536-8333
• Mailing Address - Street 1: 3800 N MAYFAIR RD
• Mailing Address - City: WAUWATOSA
• Mailing Address - State: WI
• Mailing Address - Zip Code: 53222-2200
• Mailing Address - Country: US
• Mailing Address - Phone: 414-536-8333
• Mailing Address - Fax: 414-536-8348
• Practice Address - Street 1: 3800 N MAYFAIR RD
• Practice Address - City: WAUWATOSA
• Practice Address - State: WI
• Practice Address - Zip Code: 53222-2200
• Practice Address - Country: US
• Practice Address - Phone: 414-536-8333
• Practice Address - Fax: 414-536-8348
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-02
• Last Update Date: 2021-07-16

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist		Group - Multi-Specialty
No	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WI	42133600	Medicaid
WI	000144585	Medicare PIN
WI	000044225	Medicare PIN
WI	000044215	Medicare PIN
WI	000044225	Medicare UPIN
WI	000144585	Medicare UPIN
WI	84041	Medicare ID - Type Unspecified
WI	000344215	Medicare PIN
WI	42133600	Medicaid
WI	000044585	Medicare UPIN
WI	000044755	Medicare PIN
WI	000484041	Medicare PIN
WI	000484041	Medicare UPIN
WI	000044755	Medicare UPIN
WI	000344225	Medicare PIN
WI	000344225	Medicare UPIN
WI	000044585	Medicare PIN
WI	000084041	Medicare UPIN