Provider Demographics
NPI:1932608643
Name:JOHNSON CREEK COUNSELING & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:JOHNSON CREEK COUNSELING & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEIBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-285-2487
Mailing Address - Street 1:209 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9422
Mailing Address - Country:US
Mailing Address - Phone:920-285-2487
Mailing Address - Fax:920-699-2788
Practice Address - Street 1:520 HARTWIG BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9314
Practice Address - Country:US
Practice Address - Phone:920-285-2487
Practice Address - Fax:920-699-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7792-123261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)