Provider Demographics
NPI:1356885339
Name:NORTHWOODS BEHAVIORAL HEALTH SERVICES, LLC.
Entity type:Organization
Organization Name:NORTHWOODS BEHAVIORAL HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSW, CSAC, IDP-AT
Authorized Official - Phone:715-634-4673
Mailing Address - Street 1:15617 US HIGHWAY 63
Mailing Address - Street 2:P.O. BOX 800
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-4244
Mailing Address - Country:US
Mailing Address - Phone:715-634-4673
Mailing Address - Fax:715-634-4675
Practice Address - Street 1:15617 US HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-4244
Practice Address - Country:US
Practice Address - Phone:715-634-4673
Practice Address - Fax:715-634-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health