Provider Demographics
| NPI: | 1831442359 |
|---|---|
| Name: | BEHAVIORAL HEALTH CLINIC, LLC |
| Entity type: | Organization |
| Organization Name: | BEHAVIORAL HEALTH CLINIC, LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OPERATIONS ADMINISTRATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | CHARITY |
| Authorized Official - Middle Name: | DAWN |
| Authorized Official - Last Name: | FANCHER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 715-842-9500 |
| Mailing Address - Street 1: | 630 S 36TH AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WAUSAU |
| Mailing Address - State: | WI |
| Mailing Address - Zip Code: | 54401-3930 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 715-842-9500 |
| Mailing Address - Fax: | 715-848-0425 |
| Practice Address - Street 1: | 630 S 36TH AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | WAUSAU |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 54401-3930 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 715-842-9500 |
| Practice Address - Fax: | 715-848-0425 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-10-22 |
| Last Update Date: | 2025-05-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty |
