PROFESSIONAL SERVICES GROUP INC. NPI 1598080525

NPI Information

NPI: 1598080525
Provider Name: PROFESSIONAL SERVICES GROUP, INC.
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

CLIA Number: 52D2121918

Address:
220 WASHINGTON AVENUE
OSHKOSH, WI
ZIP 54903
Phone: (920) 237-6990
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PROFESSIONAL SERVICES GROUP, INC. is a mental health counselor in Oshkosh, WI. PROFESSIONAL SERVICES GROUP, INC. NPI is 1598080525. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

220 WASHINGTON AVENUE
OSHKOSH, WI
ZIP 54903
Phone: (920) 237-6990
Fax: (920) 424-7521

The provider's authorized official is Brian A Wolf .
The authorized official title is Clinical Director and has the following contact phone number (414) 727-2789.

The CLIA number assigned to this NPI record is 52D2121918 - other - mental hlth clinic aoda with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/1/2010 and was last updated on 5/12/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	1749	WISCONSIN	No
2	101YM0800X	Counselor	Mental Health	1749	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000084462	OTHER	WISCONSIN	MEDICARE ID - TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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