| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 14353 Hwy 32/64, Mountain, 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 |
|---|---|
14353 Hwy 32/64 Mountain WI 54149 Ph: (715) 276-1600 | 14353 Hwy 32/64 Mountain WI 54149 Ph: (715) 276-1600 |
| NPI Number | 1225691017 |
|---|---|
| Provider Enumeration Date | 04/17/2019 |
| Last Update Date | 12/23/2021 |
| Certification Date | 12/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225691017 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |