| Affiliated Counseling Center Llc | |
|
108 N Lincoln Avenue Beaver Dam WI 53916 | |
| (920) 887-8751 | |
| (920) 887-3977 |
| Full Name | Affiliated Counseling Center Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 108 N Lincoln Avenue, Beaver Dam, Wisconsin |
| Authorized Official Name and Position | Sandra L Schwefel Massie (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9208878751 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affiliated Counseling Center Llc 108 N Lincoln Avenue Beaver Dam WI 53916 Ph: (920) 887-8751 | Affiliated Counseling Center Llc 108 N Lincoln Avenue Beaver Dam WI 53916 Ph: (920) 887-8751 |
| NPI Number | 1164568879 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5991790883 |
|---|---|
| Medicare Enrollment ID | O20040419001617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164568879 | NPI | - | NPPES |
| 42187100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 1018 (Wisconsin) | Primary |
| Provider Name | Sandra L Schwefel Massie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912082496 PECOS PAC ID: 1153316054 Enrollment ID: I20040420000258 |
| Provider Name | Daniel J Massie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427355445 PECOS PAC ID: 9830364363 Enrollment ID: I20111213000211 |
| Provider Name | Robert Frank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447666870 PECOS PAC ID: 0648549394 Enrollment ID: I20180816000269 |
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