| Portis Marriage And Children Counseling Clinic, Llc | |
|
5801 Washington Ave Ste 103 Racine WI 53406-4057 | |
| (262) 884-9734 | |
| (262) 884-9735 |
| Full Name | Portis Marriage And Children Counseling Clinic, Llc |
|---|---|
| Speciality | Counselor |
| Location | 5801 Washington Ave Ste 103, Racine, Wisconsin |
| Authorized Official Name and Position | Alice Faye Portis-patterson (CLINICAL DIRECTOR/THERAPIST) |
| Authorized Official Contact | 2628849734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portis Marriage And Children Counseling Clinic, Llc 5801 Washington Ave Ste 110 Racine WI 53406-4057 Ph: (262) 884-9734 | Portis Marriage And Children Counseling Clinic, Llc 5801 Washington Ave Ste 103 Racine WI 53406-4057 Ph: (262) 884-9734 |
| NPI Number | 1609046788 |
|---|---|
| Provider Enumeration Date | 03/05/2008 |
| Last Update Date | 02/15/2011 |
| Medicare PECOS PAC ID | 8527139211 |
|---|---|
| Medicare Enrollment ID | O20080624000686 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609046788 | NPI | - | NPPES |
| 39228200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 947-125 (Wisconsin) | Primary |
| Provider Name | Alice F Portis Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568515922 PECOS PAC ID: 4880658129 Enrollment ID: I20080624000670 |
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