Organization
JACOB'S WELL PRESBYTERIAN CHURCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SPENCER REA HANSEN THOMAS LPC, NCC (EXECUTIVE DIRECTOR)
(309) 532-2364
Entity
Organization
Contact information
Practice address
3340 LINEVILLE RD, GREEN BAY, WI 54313-7237
(920) 264-9564
Mailing address
3340 LINEVILLE RD, GREEN BAY, WI 54313-7237
(920) 264-9564
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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