Basic Information
| Provider Information | |||||||||
| NPI: | 1215980396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHOLISTIC HEALTH COUNSELING SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4465 N OAKLAND AVE | ||||||||
| Address2: | #300 LOWER LEVEL | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532111662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148376391 | ||||||||
| FaxNumber: | 4148376393 | ||||||||
| Practice Location | |||||||||
| Address1: | 5934 S BUSINESS DR | ||||||||
| Address2: | |||||||||
| City: | SHEBOYGAN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204599277 | ||||||||
| FaxNumber: | 9204597920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | PIASKOSKI | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4148376391 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | WI | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 42153100 | 05 | WI | MEDICAID |