Organization
MENOMINEE INDIAN TRIBE OF WISCONSIN
Active
Other names
MTC Mental Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY L WAUKAU (HEALTH ADMINISTRATOR)
(715) 799-3361
Entity
Organization
Contact information
Practice address
W3275 WOLF RIVER ROAD, KESHENA, WI 54135
(715) 799-3361
(715) 799-3099
Mailing address
PO BOX 970, KESHENA, WI 54135-0970
(715) 799-3361
(715) 799-3099
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1588
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42173700
—
WI
Enumeration date
04/02/2008
Last updated
04/02/2008
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