Organization
NORTHWEST JOURNEY - WISCONSIN RAPIDS DAY TREATM
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)
17153274402
Entity
Organization
Contact information
Practice address
110 24TH ST S, WISCONSIN RAPIDS, WI 54494-1906
(715) 424-5040
(715) 424-5720
Mailing address
110 24TH ST S, WISCONSIN RAPIDS, WI 54494-1906
(715) 424-5040
(715) 424-5720
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
2291
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42626
HEALTH PARTNERS
MN
05
—
43006100
—
WI
01
—
85575
PREFERRED ONE
MN
Enumeration date
03/26/2007
Last updated
09/23/2010
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