Organization
IMPACT COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE M MILLWOOD MS (DIRECTOR)
(715) 634-0607
Entity
Organization
Contact information
Practice address
15655 COUNTY ROAD B, HAYWARD, WI 54843-3251
(715) 634-0607
Mailing address
15655 COUNTY ROAD B, PO BOX 13251, HAYWARD, WI 54843-3251
(715) 634-0607
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
43005300
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43005300
—
WI
Enumeration date
04/18/2008
Last updated
08/11/2008
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