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1409 Cleveland Ave Marinette WI 54143-3918 | |
| (715) 735-0095 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1409 Cleveland Ave, Marinette, Wisconsin |
| Authorized Official Name and Position | Brian Charlier (COO) |
| Authorized Official Contact | 9206761148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1409 Cleveland Ave Marinette WI 54143-3918 Ph: (715) 735-0095 | 1409 Cleveland Ave Marinette WI 54143-3918 Ph: (715) 735-0095 |
| NPI Number | 1518339175 |
|---|---|
| Provider Enumeration Date | 10/22/2015 |
| Last Update Date | 08/03/2023 |
| Certification Date | 08/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518339175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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