| Brown County Community Treatment Center - Clinic | |
|
3150 Gershwin Drive Green Bay WI 54311-5859 | |
| (920) 391-6940 | |
| (920) 391-4870 |
| Full Name | Brown County Community Treatment Center - Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 3150 Gershwin Drive, Green Bay, Wisconsin |
| Authorized Official Name and Position | Eliza Killian (BEHAVIORAL HEALTH SUPERVISOR) |
| Authorized Official Contact | 9203914700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brown County Community Treatment Center - Clinic 3150 Gershwin Drive Green Bay WI 54311-5859 Ph: (920) 391-4839 | Brown County Community Treatment Center - Clinic 3150 Gershwin Drive Green Bay WI 54311-5859 Ph: (920) 391-6940 |
| NPI Number | 1942305065 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 05/10/2024 |
| Certification Date | 05/10/2024 |
| Medicare PECOS PAC ID | 1355435900 |
|---|---|
| Medicare Enrollment ID | O20100524000844 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942305065 | NPI | - | NPPES |
| 42186400 | Medicaid | WI | |
| CC6458 | Other | WI | RAILROAD MEDICARE |
| 510142673068 | Other | WI | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Koti R Mannem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720188717 PECOS PAC ID: 7911964200 Enrollment ID: I20041218000041 |
| Provider Name | Brian J Eggener |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598860363 PECOS PAC ID: 2163327198 Enrollment ID: I20060410000091 |
| Provider Name | Mary K Friess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750479820 PECOS PAC ID: 5294732178 Enrollment ID: I20061107000429 |
| Provider Name | Marshall J Bales |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467494211 PECOS PAC ID: 4284785403 Enrollment ID: I20090630000224 |
| Provider Name | Yogesh C Pareek |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093930067 PECOS PAC ID: 4082744677 Enrollment ID: I20100608000529 |
| Provider Name | Althea L Noukki |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508128901 PECOS PAC ID: 3072769249 Enrollment ID: I20120803000806 |
| Provider Name | Egbert A Tan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245427111 PECOS PAC ID: 9537330618 Enrollment ID: I20130827000937 |
| Provider Name | Kristin A Anderson-cronin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558650705 PECOS PAC ID: 7911133426 Enrollment ID: I20131111000926 |
| Provider Name | Satya Kishore Gutta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821364498 PECOS PAC ID: 8628396371 Enrollment ID: I20150409002030 |
| Provider Name | Katie Gesch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063839447 PECOS PAC ID: 5294045225 Enrollment ID: I20171006000891 |
| Provider Name | Crystal M Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548738297 PECOS PAC ID: 8628313673 Enrollment ID: I20181219000325 |
| Provider Name | Tiffany Dahlke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194353763 PECOS PAC ID: 9133537285 Enrollment ID: I20210409001219 |
| Provider Name | Neha Thapa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508155698 PECOS PAC ID: 0840608493 Enrollment ID: I20210420000812 |
| Provider Name | Whitney C Recla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407515547 PECOS PAC ID: 2860884020 Enrollment ID: I20220120000152 |
| Provider Name | Tyler G Luedke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821431099 PECOS PAC ID: 7618347212 Enrollment ID: I20221222001567 |
| Provider Name | Veronica Thomson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396406260 PECOS PAC ID: 0941657340 Enrollment ID: I20231107001200 |
| Provider Name | Lolita R Hansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255010559 PECOS PAC ID: 2264881374 Enrollment ID: I20231214003469 |
| Provider Name | Stephanie Weigman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598398760 PECOS PAC ID: 4688026701 Enrollment ID: I20240114000038 |
| Provider Name | Chelsea Julian |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952903593 PECOS PAC ID: 9133572605 Enrollment ID: I20240131003718 |
| Provider Name | Lisa M. Krueger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457541716 PECOS PAC ID: 8022461508 Enrollment ID: I20240131003832 |
| Provider Name | Jody Kress |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558612291 PECOS PAC ID: 8022451855 Enrollment ID: I20240208003678 |
| Provider Name | Melissa A Detrie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205525904 PECOS PAC ID: 6901240282 Enrollment ID: I20240214002331 |
| Provider Name | Cally Gorski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730966672 PECOS PAC ID: 0941645766 Enrollment ID: I20240301002795 |
| Provider Name | Kyle Kershek |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396500724 PECOS PAC ID: 6103263900 Enrollment ID: I20240327003975 |
Goodine Counseling Ltd Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 Circle Dr Ste B, Green Bay, WI 54304 Phone: 920-660-9797 | |
Flourish Aba Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2331 Velp Ave Ste H, Green Bay, WI 54303 Phone: 920-676-2609 | |
Thriveworks Clinical - Wisconsin Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2920 S Webster Ave Ste E, Green Bay, WI 54301 Phone: 855-284-7483 | |
Gam Behavioral Health Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3021 Holmgren Way, Suite 203a, Green Bay, WI 54304 Phone: 920-339-9307 Fax: 920-339-9374 | |
Goodine Counseling Ltd Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2300 Riverside Dr, Green Bay, WI 54301 Phone: 920-362-0447 | |
Healthy Hope Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 916 Willard Dr Ste 136, Green Bay, WI 54304 Phone: 920-328-0717 Fax: 920-328-0715 | |
Julie Feld And Associates Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 120 S Webster Ave, Green Bay, WI 54301 Phone: 920-884-8138 Fax: 920-884-8148 |