# NORTHWEST COUNSELING & GUIDANCE CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTHWEST COUNSELING & GUIDANCE CLINIC
- **Other names:** Northwest Journey-DePere
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1225155393
- **Legal business name:** NORTHWEST COUNSELING & GUIDANCE CLINIC
- **Authorized official:** JACKIE J MAURER (OFFICE SUPERVISOR)
- **Authorized official phone:** (715) 349-7069

## Contact information

- **Practice address:** 1119 W KENNEDY AVE, STE A, KIMBERLY, WI 54136-2213
- **Practice address phone:** (920) 364-9668
- **Practice address fax:** (888) 625-8634
- **Mailing address:** PO BOX 309, SIREN, WI 54872-0309
- **Mailing address phone:** (715) 349-7069
- **Mailing address fax:** (888) 625-8634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 2160 | WI | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 08/15/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 42626 | HEALTH PARTNERS | MN |
| 05 | — | 43005000 | — | WI |
| 01 | — | 85575 | PREFERRED ONE | MN |