Provider Demographics
NPI:1962544353
Name:SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN
Entity type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF SOUTHERN WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW
Authorized Official - Phone:608-663-0763
Mailing Address - Street 1:5900 MONONA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3556
Mailing Address - Country:US
Mailing Address - Phone:608-663-0763
Mailing Address - Fax:608-663-0765
Practice Address - Street 1:5900 MONONA DR STE 100
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3556
Practice Address - Country:US
Practice Address - Phone:608-663-0763
Practice Address - Fax:608-663-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIHFS 61.91101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39405400Medicaid
WI39567300Medicaid
WI43592300Medicaid
WI39127800Medicaid
WI30237400Medicaid
WI39405400Medicaid
WI39567300Medicaid
WI43592300Medicaid