Provider Demographics
NPI:1295174647
Name:INNER CIRCLE FAMILY COUNSELING
Entity type:Organization
Organization Name:INNER CIRCLE FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLEJNICZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:715-542-4075
Mailing Address - Street 1:8792 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:SAYNER
Mailing Address - State:WI
Mailing Address - Zip Code:54560-9697
Mailing Address - Country:US
Mailing Address - Phone:715-542-4075
Mailing Address - Fax:
Practice Address - Street 1:8792 SMITH ST
Practice Address - Street 2:
Practice Address - City:SAYNER
Practice Address - State:WI
Practice Address - Zip Code:54560-9697
Practice Address - Country:US
Practice Address - Phone:715-542-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI352-228261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)