Organization
GENESIS BEHAVIORAL SERVICES, INC.
Active
Parent organization
CORIZON HEALTH, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CORIZON HEALTH, INC.
Authorized official
PAULINE ORTLOFF (EXECUTIVE DIRECTOR)
(414) 777-1570
Entity
Organization
Contact information
Practice address
1626 CLARENCE COURT, WEST BEND, WI 53095
(262) 338-8611
(262) 338-3367
Mailing address
12647 OLIVE BLVD, ATTN: ACCTS. RECEIVEABLE, SAINT LOUIS, MO 63141-6393
(414) 777-1570
(414) 777-1565
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1465
WI
101YM0800X
Mental Health Counselor
1465
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1465
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42185900
—
WI
05
—
42185921
—
WI
05
—
42186000
—
WI
05
—
42242221
—
WI
Enumeration date
05/30/2008
Last updated
02/04/2014
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