PROFESSIONAL SERVICES GROUP INC. NPI 1124104740

NPI Information

  • NPI: 1124104740
  • Provider Name: PROFESSIONAL SERVICES GROUP, INC.
  • Classification: Counselor - 101YM0800X
  • Specialization: Mental Health
  • Entity Type: Organization
  • CLIA Number: 52D2170018
  • Address: 800 GOOLD ST
    RACINE, WI
    ZIP 53402
  • Phone: (262) 638-2000

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NPI Details

PROFESSIONAL SERVICES GROUP, INC. is a mental health counselor in Racine, WI. PROFESSIONAL SERVICES GROUP, INC. NPI is 1124104740. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

800 GOOLD ST
RACINE, WI
ZIP 53402-567
Phone: (262) 638-2000
Fax: (262) 638-2006

The provider's authorized official is Brian A. Wolf .
The authorized official title is Clinical Director and has the following contact phone number (262) 652-2406.

The CLIA number assigned to this NPI record is 52D2170018 - other - mental health clinic/ aod with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/27/2006 and was last updated on 6/30/2008.

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
1101YA0400XCounselorAddiction (Substance Use Disorder)2657WISCONSINNo
2101YM0800XCounselorMental Health2657WISCONSINYes

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
142246800MEDICAIDWISCONSIN
2000084462MEDICARE ID-TYPE UNSPECIFIEDWISCONSINMEDICARE

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: 3/30/2025

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