Provider Demographics
NPI:1841514916
Name:BELL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:BELL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:414-527-6940
Mailing Address - Street 1:5500 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3700
Mailing Address - Country:US
Mailing Address - Phone:262-564-0067
Mailing Address - Fax:262-652-1411
Practice Address - Street 1:5500 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3700
Practice Address - Country:US
Practice Address - Phone:262-564-0067
Practice Address - Fax:262-652-1411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELWOOD LTD./BELL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1102251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health