Provider Demographics
NPI:1770937203
Name:PALADIN COUNSELING & CONSULTATION, LLC
Entity type:Organization
Organization Name:PALADIN COUNSELING & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PLACEK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC SAC CSACIT
Authorized Official - Phone:608-325-5520
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:819 1ST AVE
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566
Mailing Address - Country:US
Mailing Address - Phone:608-325-5520
Mailing Address - Fax:608-325-5846
Practice Address - Street 1:819 1ST AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-3806
Practice Address - Country:US
Practice Address - Phone:608-325-5520
Practice Address - Fax:608-325-5846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1556226251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1659579761OtherNPI NUMBER INDIVIDUAL