Organization
INNOVATIVE COUNSELING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CYNTHIA RAE THOMAS MSW ACSW (CLINICAL DIRECTOR)
(920) 497-6161
Entity
Organization
Contact information
Practice address
1499 6TH ST, INNOVATIVE COUNSELING INC, GREEN BAY, WI 54304-2252
(920) 497-6161
(920) 498-0476
Mailing address
1499 6TH ST, INNOVATIVE COUNSELING INC, GREEN BAY, WI 54304-2252
(920) 497-6161
(920) 498-0476
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2283
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42207500
—
WI
05
—
WI1391
—
WI
Enumeration date
01/22/2007
Last updated
03/15/2010
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