Organization
MICHAEL J. MERVILDE,MSW
Active
Other names
d/b/a Green Bay Wellness & Behavioral Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN SUE MERVILDE (OFFICE MANAGER)
(920) 437-7878
Entity
Organization
Contact information
Practice address
125 S JEFFERSON ST, SUITE 306, GREEN BAY, WI 54301-4500
(920) 437-7878
(920) 437-5884
Mailing address
125 S JEFFERSON ST, SUITE 306, GREEN BAY, WI 54301-4500
(920) 437-7878
(920) 437-5884
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
107-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42158800
—
WI
Enumeration date
09/20/2006
Last updated
07/16/2008
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