Organization
FAMILY ACHIEVEMENT CLINIC S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL M CORNALE MS (DIRECTOR)
(262) 567-4560
Entity
Organization
Contact information
Practice address
24 S MAIN ST, OCONOMOWOC, WI 53066-5226
(262) 567-4560
(262) 567-4870
Mailing address
24 S MAIN ST, OCONOMOWOC, WI 53066-5226
(262) 567-4560
(262) 567-4870
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1313
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42124500
—
WI
Enumeration date
04/07/2008
Last updated
04/07/2008
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