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Organization
NORTHWEST COUNSELING & GUIDANCE CLINIC
Active
Organization
NORTHWEST COUNSELING & GUIDANCE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE J MAURER (BUSINESS OFFICE SUPERVISOR)
(715) 327-4322
Entity
Organization
Contact information
Practice address
203 UNITED WAY DRIVE, FREDERIC, WI 54837-8938
(715) 327-4402
(715) 327-4470
Mailing address
203 UNITED WAY DRIVE, FREDERIC, WI 54837-8938
(715) 327-4322
(715) 327-8509
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2254
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42214000
—
WI
01
—
42626
HEALTH PARTNERS
MN
01
—
7H956NO
BCBS OF MN
MN
01
—
85575
PREFERRED ONE
MN
Enumeration date
11/18/2006
Last updated
03/27/2012
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