# NORTHWEST COUNSELING AND GUIDANCE - NORTHWEST JOURNEY - SUPERIOR

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

## Provider details

- **NPI number:** 1982821575
- **Legal business name:** NORTHWEST COUNSELING AND GUIDANCE CLINIC
- **Authorized official:** MR. NICK KALAMBOKIDIS (CFO)
- **Authorized official phone:** (715) 327-4402

## Contact information

- **Practice address:** 1419 HILL AVE STE B, SUPERIOR, WI 54880-1951
- **Practice address phone:** (715) 395-3805
- **Practice address fax:** (715) 424-5720
- **Mailing address:** 1412 E SECOND STREET, SUPERIOR, ID 54880
- **Mailing address phone:** (715) 395-3805
- **Mailing address fax:** (715) 424-5720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 2074 | WI | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 10/22/2009

## 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 | — |