Provider Demographics
NPI:1801308218
Name:NORTHWEST COUNSELING & GUIDANCE CLINIC, INC.
Entity type:Organization
Organization Name:NORTHWEST COUNSELING & GUIDANCE CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-327-7112
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0309
Mailing Address - Country:US
Mailing Address - Phone:715-327-7112
Mailing Address - Fax:888-625-8634
Practice Address - Street 1:221 FIFTH STREET
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521
Practice Address - Country:US
Practice Address - Phone:715-365-9735
Practice Address - Fax:888-226-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health