Provider Demographics
NPI:1841471844
Name:DOMINION BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:DOMINION BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CAPSW
Authorized Official - Phone:262-751-7507
Mailing Address - Street 1:W132N6303 MARACH RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6022
Mailing Address - Country:US
Mailing Address - Phone:262-751-7507
Mailing Address - Fax:262-252-7567
Practice Address - Street 1:W132N6303 MARACH RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-6022
Practice Address - Country:US
Practice Address - Phone:262-751-7507
Practice Address - Fax:262-252-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2045-121251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42248000Medicaid