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Organization

PINE COUNSELING INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELIJAH LAKE KRAMER SAC-IT (BOARD MEMBER)
(920) 285-0453
Entity
Organization

Contact information

Practice address
204 S ORANGE ST, RICHLAND CENTER, WI 53581-2170
(931) 982-4832
(608) 383-1480
Mailing address
204 S ORANGE ST, RICHLAND CENTER, WI 53581-2170
(931) 982-4832
(608) 383-1480

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1184006652
WI
Enumeration date
06/29/2019
Last updated
12/08/2019
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