Provider Demographics
NPI:1962938381
Name:CLOVERLEAF COUNSELING, LLC
Entity type:Organization
Organization Name:CLOVERLEAF COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ZAKRZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:920-843-0091
Mailing Address - Street 1:3019 W SPENCER ST
Mailing Address - Street 2:#202
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5945
Mailing Address - Country:US
Mailing Address - Phone:920-843-0091
Mailing Address - Fax:
Practice Address - Street 1:3019 W SPENCER ST
Practice Address - Street 2:#202
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5945
Practice Address - Country:US
Practice Address - Phone:920-843-0091
Practice Address - Fax:855-849-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7452-123261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7452-123OtherSTATE LICENSE WISCONSIN
WI7452-123OtherSTATE LICENSE WISCONSIN