Provider Demographics
NPI:1952731465
Name:YOUR PLACE COUNSELING SERVICES
Entity Type:Organization
Organization Name:YOUR PLACE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:414-315-9323
Mailing Address - Street 1:404 N MAIN ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4957
Mailing Address - Country:US
Mailing Address - Phone:920-230-2363
Mailing Address - Fax:
Practice Address - Street 1:404 N MAIN ST
Practice Address - Street 2:SUITE 507
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4957
Practice Address - Country:US
Practice Address - Phone:920-230-2363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5077125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437465283Medicaid