1417107590 NPI number — NEW HOPE COUNSELING CENTER OF WI, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417107590 NPI number — NEW HOPE COUNSELING CENTER OF WI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HOPE COUNSELING CENTER OF WI, 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:
Provider Other Organization Name Type Code:
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:
1417107590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3021 HOLMGREN WAY
Provider Second Line Business Mailing Address:
#203
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54304-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-338-0100
Provider Business Mailing Address Fax Number:
920-338-0103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3021 HOLMGREN WAY
Provider Second Line Business Practice Location Address:
#203
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54304-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-338-0100
Provider Business Practice Location Address Fax Number:
920-338-0103
Provider Enumeration Date:
09/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAWNICZAK
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER/PSYCHOTHERAPIST
Authorized Official Telephone Number:
920-338-0100

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2760-125 , 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)





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