| Jacob's Well Presbyterian Church | |
|
3340 Lineville Rd Green Bay WI 54313-7237 | |
| (920) 264-9564 | |
| Not Available |
| Full Name | Jacob's Well Presbyterian Church |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3340 Lineville Rd, Green Bay, Wisconsin |
| Authorized Official Name and Position | Spencer Rea Hansen Thomas (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3095322364 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob's Well Presbyterian Church 3340 Lineville Rd Green Bay WI 54313-7237 Ph: (920) 264-9564 | Jacob's Well Presbyterian Church 3340 Lineville Rd Green Bay WI 54313-7237 Ph: (920) 264-9564 |
| NPI Number | 1124798970 |
|---|---|
| Provider Enumeration Date | 09/14/2021 |
| Last Update Date | 09/14/2021 |
| Certification Date | 09/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124798970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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