| Jacob's Well Counseling Center Inc | |
|
3340 Lineville Rd Green Bay WI 54313-7237 | |
| (920) 562-6236 | |
| Not Available |
| Full Name | Jacob's Well Counseling Center Inc |
|---|---|
| Speciality | Counselor |
| Location | 3340 Lineville Rd, Green Bay, Wisconsin |
| Authorized Official Name and Position | Abigail Ronholt (ADMINISTRATOR) |
| Authorized Official Contact | 9209312531 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob's Well Counseling Center Inc 3340 Lineville Rd Green Bay WI 54313-7237 Ph: () - | Jacob's Well Counseling Center Inc 3340 Lineville Rd Green Bay WI 54313-7237 Ph: (920) 562-6236 |
| NPI Number | 1609558485 |
|---|---|
| Provider Enumeration Date | 08/02/2023 |
| Last Update Date | 04/25/2024 |
| Certification Date | 04/25/2024 |
| Medicare PECOS PAC ID | 1456799006 |
|---|---|
| Medicare Enrollment ID | O20240402003439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609558485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Bruce J Robertson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396770434 PECOS PAC ID: 2365344801 Enrollment ID: I20040123000918 |
| Provider Name | Erin Luttschwager |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861122665 PECOS PAC ID: 4688015233 Enrollment ID: I20240514000651 |
| Provider Name | Spencer Rea Hansen Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760099329 PECOS PAC ID: 4183062730 Enrollment ID: I20240516001348 |
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