Provider Demographics
NPI:1316439292
Name:GAINING INSIGHT COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:GAINING INSIGHT COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:WITTENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-509-1856
Mailing Address - Street 1:1241 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-3753
Mailing Address - Country:US
Mailing Address - Phone:715-614-0769
Mailing Address - Fax:
Practice Address - Street 1:1840 EVANS ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2362
Practice Address - Country:US
Practice Address - Phone:920-509-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6701-125261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100075907Medicaid