| Jefferson County Human Service Dept-mental Health | |
|
1541 Annex Rd Jefferson WI 53549 | |
| (920) 674-3105 | |
| (920) 674-6113 |
| Full Name | Jefferson County Human Service Dept-mental Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 1541 Annex Rd, Jefferson, Wisconsin |
| Authorized Official Name and Position | Brian Bellford (DEPUTY DIRECTOR) |
| Authorized Official Contact | 9206748147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson County Human Service Dept-mental Health 1541 Annex Rd Jefferson WI 53549 Ph: (920) 674-3105 | Jefferson County Human Service Dept-mental Health 1541 Annex Rd Jefferson WI 53549 Ph: (920) 674-3105 |
| NPI Number | 1275614919 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 09/12/2024 |
| Certification Date | 09/12/2024 |
| Medicare PECOS PAC ID | 2264496801 |
|---|---|
| Medicare Enrollment ID | O20041115000371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275614919 | NPI | - | NPPES |
| 42138100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1449 (Wisconsin) | Primary |
| Provider Name | Melvin A Haggart |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902919087 PECOS PAC ID: 5496719890 Enrollment ID: I20041116000384 |
| Provider Name | Mary T Bonaccorsi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811927205 PECOS PAC ID: 4587668660 Enrollment ID: I20060901000098 |
| Provider Name | Holly R Pagel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245569524 PECOS PAC ID: 3779718184 Enrollment ID: I20131021000042 |
| Provider Name | Michele L Bahl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376762682 PECOS PAC ID: 2769707421 Enrollment ID: I20150220002338 |
| Provider Name | Rabecca Catherine Cole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023670445 PECOS PAC ID: 6507191533 Enrollment ID: I20190715000329 |
| Provider Name | Jeannine M Eng |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881843282 PECOS PAC ID: 4082045174 Enrollment ID: I20200505000647 |
| Provider Name | Alex James |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588218994 PECOS PAC ID: 6305250424 Enrollment ID: I20210202001035 |
| Provider Name | Jamie Jo Tegt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245690007 PECOS PAC ID: 5395150049 Enrollment ID: I20210210003348 |
| Provider Name | Emily A Stout |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457984254 PECOS PAC ID: 3072928944 Enrollment ID: I20221104002633 |
| Provider Name | Anna Falci |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467006817 PECOS PAC ID: 6002289329 Enrollment ID: I20230307000630 |
| Provider Name | Sara Kay Zwieg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275143521 PECOS PAC ID: 5193199578 Enrollment ID: I20230327001074 |
| Provider Name | Brianna Lesle White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962050625 PECOS PAC ID: 9931566361 Enrollment ID: I20230531000205 |
| Provider Name | Eric Lewis Diamond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144578014 PECOS PAC ID: 9537473418 Enrollment ID: I20230720003429 |
| Provider Name | Michelle Rushton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235778861 PECOS PAC ID: 5597111369 Enrollment ID: I20231031000993 |
| Provider Name | Amanda Sass |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104572718 PECOS PAC ID: 1355793118 Enrollment ID: I20240117001276 |
| Provider Name | Amy Porter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295132702 PECOS PAC ID: 7416309299 Enrollment ID: I20240117002109 |
| Provider Name | Katherin Almira Schultz |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1659719680 PECOS PAC ID: 0042662850 Enrollment ID: I20240117003112 |
| Provider Name | Matthew Baumann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396408951 PECOS PAC ID: 0345638219 Enrollment ID: I20240117004001 |
| Provider Name | Brooke T Kysely |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487247326 PECOS PAC ID: 9537512751 Enrollment ID: I20240124001734 |
| Provider Name | Krista Doerr |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669602413 PECOS PAC ID: 0345426698 Enrollment ID: I20240125004596 |
| Provider Name | Emily E Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669042503 PECOS PAC ID: 5890138788 Enrollment ID: I20240207003484 |
| Provider Name | Jennifer Lynn Wendt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578793964 PECOS PAC ID: 5991981722 Enrollment ID: I20240215000553 |
| Provider Name | Betsy Lane |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457729436 PECOS PAC ID: 3779921598 Enrollment ID: I20240329000557 |
Wellnite Medical Group Pa Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 148 E Milwaukee St, Jefferson, WI 53549 Phone: 877-644-6008 | |
K Bare Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1031 S Main Street, Jefferson, WI 53549 Phone: 920-541-3677 Fax: 920-541-3678 | |
Jefferson County Human Services-crisis Intervention, Billing Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1541 Annex Rd, Jefferson, WI 53549 Phone: 920-674-3105 Fax: 920-674-6113 | |
Jefferson County Human Services-comprehensive Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1541 Annex Rd, Jefferson, WI 53549 Phone: 920-674-3105 Fax: 920-674-6113 | |
Jefferson County Human Services - Ccs Billing Provider Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1541 Annex Rd, Jefferson, WI 53549 Phone: 920-674-3105 Fax: 920-674-6113 | |
Family Resources Associates Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 248 S Wisconsin Drive, Jefferson, WI 53549 Phone: 920-261-4100 Fax: 920-261-8801 |