Provider Demographics
NPI:1841570447
Name:GEORGE SONCRANT D/B/A BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:GEORGE SONCRANT D/B/A BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SLAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-632-7040
Mailing Address - Street 1:3000 RIVERSIDE DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-1653
Mailing Address - Country:US
Mailing Address - Phone:920-632-7040
Mailing Address - Fax:920-632-7262
Practice Address - Street 1:3000 RIVERSIDE DR
Practice Address - Street 2:SUITE 180
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1653
Practice Address - Country:US
Practice Address - Phone:920-632-7040
Practice Address - Fax:920-632-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI2154Medicare PIN