Organization
TRIVIUM LLC
Active
Other names
Crossroads Counseling Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY F. PERRY MSSW, LCSW, LMFT (ADMINISTRATOR)
(608) 755-5260
Entity
Organization
Contact information
Practice address
17 S. RIVER ST., SUITE 254, JANESVILLE, WI 53548-3863
(608) 755-5260
(608) 755-5267
Mailing address
17 S. RIVER ST, SUITE 254, JANESVILLE, WI 53548-3863
(608) 755-5260
(608) 755-5267
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1265
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
1265
WI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
2868
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42105900
—
WI
Enumeration date
07/17/2006
Last updated
12/11/2014
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