| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 200 S Rosera St, Lena, Wisconsin |
| Authorized Official Name and Position | Brian Charlier (PRESIDENT/CEO) |
| Authorized Official Contact | 9206761148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 13508 Green Bay WI 54307-3508 Ph: (920) 433-8044 | 200 S Rosera St Lena WI 54139-9169 Ph: (920) 829-6400 |
| NPI Number | 1679136683 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 12/23/2021 |
| Certification Date | 12/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679136683 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |