Organization
PROFESSIONAL SERVICES GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN A WOLF PHD (CLINICAL DIRECTOR)
(414) 727-2789
Entity
Organization
Contact information
Practice address
220 WASHINGTON AVENUE, OSHKOSH, WI 54903
(920) 237-6990
(920) 424-7521
Mailing address
1126 S. 70TH STREET, SUITE S-507, WEST ALLIS, WI 53214-3151
(414) 727-2789
(414) 476-8695
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1749
WI
101YM0800X
Mental Health Counselor
Primary
1749
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000084462
MEDICARE ID - TYPE UNSPECIFIED
WI
Enumeration date
04/01/2010
Last updated
05/12/2010
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