| Pine Counseling Inc. | |
|
204 S Orange St Richland Center WI 53581-2170 | |
| (931) 982-4832 | |
| (608) 383-1480 |
| Full Name | Pine Counseling Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 204 S Orange St, Richland Center, Wisconsin |
| Authorized Official Name and Position | Elijah Lake Kramer (BOARD MEMBER) |
| Authorized Official Contact | 9202850453 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Counseling Inc. 204 S Orange St Richland Center WI 53581-2170 Ph: (931) 982-4832 | Pine Counseling Inc. 204 S Orange St Richland Center WI 53581-2170 Ph: (931) 982-4832 |
| NPI Number | 1366004384 |
|---|---|
| Provider Enumeration Date | 06/29/2019 |
| Last Update Date | 12/08/2019 |
| Certification Date | 12/08/2019 |
| Medicare PECOS PAC ID | 7719312909 |
|---|---|
| Medicare Enrollment ID | O20200116000664 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366004384 | NPI | - | NPPES |
| 1184006652 | Medicaid | WI |
| Provider Name | Ashley Michelle Martyniuk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184006652 PECOS PAC ID: 9335574524 Enrollment ID: I20200116001100 |
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