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Organization
JANESVILLE PSYCHIATRIC CLINIC MAIN INC
Active
Organization
JANESVILLE PSYCHIATRIC CLINIC MAIN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM HOLLINGSWORTH (CLINIC DIRECTOR, OWNER)
(608) 755-1475
Entity
Organization
Contact information
Practice address
15 W MILWAUKEE ST, SUITE 206 & 207, JANESVILLE, WI 53548-2998
(608) 755-1475
(608) 755-1733
Mailing address
15 W MILWAUKEE ST, SUITE 206 & 207, JANESVILLE, WI 53548-2998
(608) 755-1475
(608) 755-1733
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1448
WI
101YM0800X
Mental Health Counselor
Primary
1448
WI
103T00000X
Psychologist
1448
WI
103TC2200X
Clinical Child & Adolescent Psychologist
1448
WI
1041C0700X
Clinical Social Worker
1448
WI
106H00000X
Marriage & Family Therapist
1448
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659447704
—
WI
05
—
42123800
—
WI
05
—
43007200
—
WV
Enumeration date
11/28/2006
Last updated
11/02/2015
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