1891863494 NPI number — NORTH CENTRAL COUNSELING CENTER, INC.

Table of content: (NPI 1891863494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891863494 NPI number — NORTH CENTRAL COUNSELING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL COUNSELING CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOSEPH F. ROE, PSYD & ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891863494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STETSONVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54480-0105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-678-2250
Provider Business Mailing Address Fax Number:
715-678-2662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 E COUNTY ROAD A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STETSONVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54480-9587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-678-2250
Provider Business Practice Location Address Fax Number:
715-678-2662
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOLTIS
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
715-678-2250

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1563123 . This is a "DEPT OF REGULATION & LIC" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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