| D/b/a Green Bay Wellness & Behavioral Health Clinic | |
|
125 S Jefferson St Suite 306 Green Bay WI 54301-4500 | |
| (920) 437-7878 | |
| (920) 437-5884 |
| Full Name | D/b/a Green Bay Wellness & Behavioral Health Clinic |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 125 S Jefferson St, Green Bay, Wisconsin |
| Authorized Official Name and Position | Karen Sue Mervilde (OFFICE MANAGER) |
| Authorized Official Contact | 9204377878 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D/b/a Green Bay Wellness & Behavioral Health Clinic 125 S Jefferson St Suite 306 Green Bay WI 54301-4500 Ph: (920) 437-7878 | D/b/a Green Bay Wellness & Behavioral Health Clinic 125 S Jefferson St Suite 306 Green Bay WI 54301-4500 Ph: (920) 437-7878 |
| NPI Number | 1871691667 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 07/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871691667 | NPI | - | NPPES |
| 42158800 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 107-123 (Wisconsin) | Primary |
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