Provider Demographics
NPI:1285734210
Name:BAY AREA MENTAL HEALTH CENTER INC
Entity type:Organization
Organization Name:BAY AREA MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MSED LPC
Authorized Official - Phone:715-373-2233
Mailing Address - Street 1:101 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-4525
Mailing Address - Country:US
Mailing Address - Phone:715-373-2233
Mailing Address - Fax:715-373-5530
Practice Address - Street 1:101 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-4525
Practice Address - Country:US
Practice Address - Phone:715-373-2233
Practice Address - Fax:715-373-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1080OtherST CERT #
WI42164100Medicaid
WI42164100Medicaid