Provider Demographics
| NPI: | 1245265693 |
|---|---|
| Name: | COUNTY OF DOOR-DOOR COUNTY LIBRARY |
| Entity type: | Organization |
| Organization Name: | COUNTY OF DOOR-DOOR COUNTY LIBRARY |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | AGENCY DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JOSEPH |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | KREBSBACH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 920-746-2343 |
| Mailing Address - Street 1: | 421 NEBRASKA ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | STURGEON BAY |
| Mailing Address - State: | WI |
| Mailing Address - Zip Code: | 54235-2225 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 920-746-7155 |
| Mailing Address - Fax: | 920-746-2439 |
| Practice Address - Street 1: | 421 NEBRASKA ST |
| Practice Address - Street 2: | |
| Practice Address - City: | STURGEON BAY |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 54235-2225 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 920-746-2345 |
| Practice Address - Fax: | 920-746-2439 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-07-12 |
| Last Update Date: | 2024-02-26 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WI | 1283 | 101YA0400X, 101YM0800X, 103TC1900X, 1041C0700X, 261QM1300X, 261QM0801X |
| 103TB0200X, 103TM1800X, 106H00000X, 235Z00000X, 251B00000X, 251K00000X, 261QM0801X | ||
| WI | 2159 | 251S00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251K00000X | Agencies | Public Health or Welfare | Group - Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WI | 42140200 | Medicaid | |
| WI | 43112400 | Medicaid | |
| WI | 43090300 | Medicaid | |
| WI | 41210100 | Medicaid | |
| WI | 43424300 | Medicaid | |
| WI | 43424300 | Medicaid | |
| WI | 41210100 | Medicaid |
