Provider Demographics
NPI:1912499351
Name:QUEST COUNSELING AND CONSULTATION CENTER, LLC
Entity Type:Organization
Organization Name:QUEST COUNSELING AND CONSULTATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:847-708-4192
Mailing Address - Street 1:740 REGENT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2648
Mailing Address - Country:US
Mailing Address - Phone:847-708-4192
Mailing Address - Fax:
Practice Address - Street 1:740 REGENT ST STE 103
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2648
Practice Address - Country:US
Practice Address - Phone:847-708-4192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5616-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI101YP2500XMedicaid