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JANESVILLE PSYCHIATRIC CLINIC MAIN INC NPI 1659447704


NPI Information

NPI: 1659447704
Provider Name: JANESVILLE PSYCHIATRIC CLINIC MAIN INC
Classification: Counselor - 101YM0800X
Entity Type: Organization

Specialization: Mental Health

CLIA Number: 52D1091528

Address:
15 W MILWAUKEE ST
SUITE 206 & 207
JANESVILLE, WI
ZIP 53548
Phone: (608) 755-1475
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JANESVILLE PSYCHIATRIC CLINIC MAIN INC is a mental health counselor in Janesville, WI. JANESVILLE PSYCHIATRIC CLINIC MAIN INC NPI is 1659447704. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

15 W MILWAUKEE ST
SUITE 206 & 207
JANESVILLE, WI
ZIP 53548-998
Phone: (608) 755-1475
Fax: (608) 755-1733

The provider's authorized official is William Hollingsworth .
The authorized official title is Clinic Director, Owner and has the following contact phone number (608) 755-1475.

The CLIA number assigned to this NPI record is 52D1091528 - ambulatory surgery center with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 11/28/2006 and was last updated on 11/2/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101YA0400XCounselorAddiction (Substance Use Disorder)1448WISCONSINNo
2103T00000XPsychologist1448WISCONSINNo
3103TC2200XPsychologistClinical Child & Adolescent1448WISCONSINNo
41041C0700XSocial WorkerClinical1448WISCONSINNo
5106H00000XMarriage & Family Therapist1448WISCONSINNo
6101YM0800XCounselorMental Health1448WISCONSINYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
143007200MEDICAIDWEST VIRGINIA
242123800MEDICAIDWISCONSIN
3B53373MEDICARE UPINWISCONSIN
454285MEDICARE ID-TYPE UNSPECIFIEDWISCONSIN
51659447704MEDICAIDWISCONSIN

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: 4/28/2024

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