Provider Demographics
NPI:1104145416
Name:NORTHWEST COUNSELING AND GUIDANCE CLINIC
Entity type:Organization
Organization Name:NORTHWEST COUNSELING AND GUIDANCE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAMBOKIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-327-4402
Mailing Address - Street 1:2860 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4898
Mailing Address - Country:US
Mailing Address - Phone:715-425-5110
Mailing Address - Fax:715-425-5120
Practice Address - Street 1:2860 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-4898
Practice Address - Country:US
Practice Address - Phone:715-425-5110
Practice Address - Fax:715-425-5120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST COUNSELING AND GUIDANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2909261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health