# NORTHWEST COUNSELING & GUIDANCE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** NORTHWEST COUNSELING AND GUIDANCE CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275650350
- **Legal business name:** NORTHWEST COUNSELING AND GUIDANCE CLINIC
- **Authorized official:** JACKIE J MAURER (BILLING OFFICE SUPERVISOR)
- **Authorized official phone:** (715) 327-4322

## Contact information

- **Practice address:** 5655 N. 28TH AVE, WAUSAU, WI 54401-9709
- **Practice address phone:** (715) 675-5454
- **Practice address fax:** (715) 675-0545
- **Mailing address:** 203 UNITED WAY, FREDERIC, WI 54837-8938
- **Mailing address phone:** (715) 327-4322
- **Mailing address fax:** (715) 327-8509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 2404 | WI | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | WI | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 11/23/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 42626 | HEALTH PARTNERS | MN |
| 05 | — | 4300700 | — | WI |
| 05 | — | 43007000 | — | WI |
| 01 | — | 85575 | PREFERRED ONE | MN |