Organization
PROFESSIONAL SERVICES GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN A. WOLF PHD (CLINICAL DIRECTOR)
(262) 652-2406
Entity
Organization
Contact information
Practice address
800 GOOLD ST, RACINE, WI 53402-4567
(262) 638-2000
(262) 638-2006
Mailing address
6233 39TH AVE, KENOSHA, WI 53142-7015
(262) 654-1004
(262) 654-6960
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2657
WI
101YM0800X
Mental Health Counselor
Primary
2657
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42246800
—
WI
Enumeration date
10/27/2006
Last updated
06/30/2008
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