Provider Demographics
NPI:1063693273
Name:CHILD AND FAMILY CONSULTANTS
Entity type:Organization
Organization Name:CHILD AND FAMILY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ROTHERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:920-497-0788
Mailing Address - Street 1:840 WILLARD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5204
Mailing Address - Country:US
Mailing Address - Phone:920-497-0788
Mailing Address - Fax:920-497-0792
Practice Address - Street 1:840 WILLARD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5204
Practice Address - Country:US
Practice Address - Phone:920-497-0788
Practice Address - Fax:920-497-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40554-020261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health