# SWEETGRASS BEHAVIORAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508574328
- **Authorized official:** ALEGRA FOWLER LCSW (OWNER)
- **Authorized official phone:** (715) 280-8130

## Contact information

- **Practice address:** 102 E GREEN BAY ST STE 101, SHAWANO, WI 54166-2444
- **Practice address phone:** (715) 280-8130
- **Practice address fax:** (715) 280-8138
- **Mailing address:** 102 E GREEN BAY ST STE 101, SHAWANO, WI 54166-2444
- **Mailing address phone:** (715) 280-8130
- **Mailing address fax:** (715) 280-8138

## Taxonomy

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

## Other

- **Enumeration date:** 11/10/2022
- **Last updated:** 12/20/2022