| Genesis Behavioral Services, Inc | |
|
1626 Clarence Ct West Bend WI 53095-8533 | |
| (262) 338-8611 | |
| (262) 338-3367 |
| Full Name | Genesis Behavioral Services, Inc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1626 Clarence Ct, West Bend, Wisconsin |
| Authorized Official Name and Position | Kimberly A Kunz (DIRECTOR) |
| Authorized Official Contact | 2623388611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Behavioral Services, Inc 1626 Clarence Ct West Bend WI 53095-8533 Ph: (262) 338-8611 | Genesis Behavioral Services, Inc 1626 Clarence Ct West Bend WI 53095-8533 Ph: (262) 338-8611 |
| NPI Number | 1043588254 |
|---|---|
| Provider Enumeration Date | 12/02/2011 |
| Last Update Date | 01/21/2021 |
| Certification Date | 01/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043588254 | NPI | - | NPPES |
| 1568620466 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 16431 - 130 (Wisconsin) | Primary |
| 251S00000X | Community/behavioral Health | 16431 - 130 (Wisconsin) | Secondary |
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