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Organization

NORTHWEST JOURNEY - ELLSWORTH

Active
Parent organization
NORTHWEST COUNSELING AND GUIDANCE CLINIC
Organization subpart
Yes

Provider details

NPI number
Legal business name
NORTHWEST COUNSELING AND GUIDANCE CLINIC
Authorized official
MR. NICK KALAMBOKIDIS (CFO)
(715) 327-4402
Entity
Organization

Contact information

Practice address
N6096 530TH ST, ELLSWORTH, WI 54011-5107
(715) 273-0203
(715) 273-0344
Mailing address
N6096 530TH ST, ELLSWORTH, WI 54011-5107
(715) 273-0203
(715) 273-0344

Taxonomy

Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
2326
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1306965033
HUMANA
WI
01
42626
HEALTH PARTNERS
MN
05
43006700
WI
01
7H956NO
BCBS OF MN
MN
01
85575
PREFERRED ONE
MN
Enumeration date
03/27/2007
Last updated
09/23/2010
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