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Organization
NORTHWEST COUNSELING AND GUIDANCE - NORTHWEST JOURNEY - SUPERIOR
Active
Organization
NORTHWEST COUNSELING AND GUIDANCE - NORTHWEST JOURNEY - SUPERIOR
Active
Parent organization
NORTHWEST COUNSELING AND GUIDANCE CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHWEST COUNSELING AND GUIDANCE CLINIC
Authorized official
MR. NICK KALAMBOKIDIS (CFO)
(715) 327-4402
Entity
Organization
Contact information
Practice address
1419 HILL AVE STE B, SUPERIOR, WI 54880-1951
(715) 395-3805
(715) 424-5720
Mailing address
1412 E SECOND STREET, SUPERIOR, ID 54880
(715) 395-3805
(715) 424-5720
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
2074
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42626
HEALTH PARTNERS
MN
05
—
43004700
—
WI
01
—
7H956NO
BCBS OF MN
MN
01
—
85575
PREFERRED ONE
MN
01
—
HUMANA
HUMANA
—
01
—
VALUE OPTIONS
VALUE OPTIONS
—
Enumeration date
04/18/2007
Last updated
10/22/2009
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