# NORTHWEST JOURNEY - MENOMONIE DAY TREATMENT

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

## Provider details

- **NPI number:** 1770600413
- **Legal business name:** NORTHWEST COUNSELING AND GUIDANCE CLINIC
- **Authorized official:** MR. NICK KALAMBOKIDIS (CFO)
- **Authorized official phone:** (715) 327-4402

## Contact information

- **Practice address:** 402 TECHNOLOGY DRIVE E, MENOMONIE, WI 54751
- **Practice address phone:** (718) 523-5424
- **Practice address fax:** (715) 235-4421
- **Mailing address:** 402 TECHNOLOGY DRIVE E, MENOMONIE, WI 54751
- **Mailing address phone:** (718) 523-5424
- **Mailing address fax:** (715) 235-4421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 2660 | WI | Yes |

## Other

- **Enumeration date:** 03/26/2007
- **Last updated:** 09/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 42626 | HEALTH PARTNERS | MN |
| 05 | — | 43009000 | — | WI |
| 01 | — | 85575 | PREFERRED ONE | MN |