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Organization
TRIVIUM LLC
Active
Organization
TRIVIUM LLC
Active
Other names
Crossroads Counseling Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY F. PERRY MSSW, LCSW, LMFT (ADMINISTRATOR)
(608) 755-5260
Entity
Organization
Contact information
Practice address
17 S. RIVER ST., SUITE 254, JANESVILLE, WI 53548-3863
(608) 755-5260
(608) 755-5267
Mailing address
17 S. RIVER ST, SUITE 254, JANESVILLE, WI 53548-3863
(608) 755-5260
(608) 755-5267
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1265
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
1265
WI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
2868
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42105900
—
WI
Enumeration date
07/17/2006
Last updated
12/11/2014
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