Organization
PHOENIX BEHAVIORAL HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD C EIDEN PHD (PSYCHOLOGIST)
(920) 657-1780
Entity
Organization
Contact information
Practice address
3120 MEMORIAL DR, TWO RIVERS, WI 54241-3229
(920) 657-1780
(920) 657-1784
Mailing address
3120 MEMORIAL DR, TWO RIVERS, WI 54241-3229
(920) 657-1780
(920) 657-1784
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42226300
—
WI
Enumeration date
07/23/2006
Last updated
02/22/2022
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