Provider Demographics
NPI:1184891152
Name:MARRIAGE & FAMILY HEALTH SERVICES, LTD.
Entity type:Organization
Organization Name:MARRIAGE & FAMILY HEALTH SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-832-0238
Mailing Address - Street 1:2925 MONDOVI RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6141
Mailing Address - Country:US
Mailing Address - Phone:715-832-0238
Mailing Address - Fax:715-832-0771
Practice Address - Street 1:501 S CHERRY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4263
Practice Address - Country:US
Practice Address - Phone:715-486-8302
Practice Address - Fax:715-486-9253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARRIAGE & FAMILY HEALTH SERVICES, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42243300Medicaid
WI223799OtherMHN/TRICARE INS. CO
WI223799OtherMHN/TRICARE INS. CO