| Professional Services Group, Inc. | |
|
800 Goold St Racine WI 53402-4567 | |
| (262) 638-2000 | |
| (262) 638-2006 |
| Full Name | Professional Services Group, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 800 Goold St, Racine, Wisconsin |
| Authorized Official Name and Position | Brian A. Wolf (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2626522406 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Services Group, Inc. 6233 39th Ave Kenosha WI 53142-7015 Ph: (262) 654-1004 | Professional Services Group, Inc. 800 Goold St Racine WI 53402-4567 Ph: (262) 638-2000 |
| NPI Number | 1124104740 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 06/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124104740 | NPI | - | NPPES |
| 42246800 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 2657 (Wisconsin) | Secondary |
| 101YM0800X | Counselor - Mental Health | 2657 (Wisconsin) | Primary |
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