1457619389 NPI number — ADVOCATE PSYCHOTHERAPY SERVICES LLC

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 1457619389 NPI number — ADVOCATE PSYCHOTHERAPY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVOCATE PSYCHOTHERAPY SERVICES LLC
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:
1457619389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 959
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENS POINT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54481-0959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-544-4435
Provider Business Mailing Address Fax Number:
800-681-2374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3233A BUSINESS PARK DR STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENS POINT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54482-8861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-544-4435
Provider Business Practice Location Address Fax Number:
715-952-4995
Provider Enumeration Date:
04/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-544-4435

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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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