Provider Demographics
NPI:1992972970
Name:MARRIAGE & FAMILY HEALTH SERVICES LTD
Entity type:Organization
Organization Name:MARRIAGE & FAMILY HEALTH SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-832-0238
Mailing Address - Street 1:2925 MONDOVI RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6141
Mailing Address - Country:US
Mailing Address - Phone:715-832-0238
Mailing Address - Fax:715-832-0771
Practice Address - Street 1:2925 MONDOVI RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6141
Practice Address - Country:US
Practice Address - Phone:715-832-0238
Practice Address - Fax:715-832-0771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARRIAGE & FAMILY HEALTH SERVICES LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42121000Medicaid
WI223799OtherMHN/TRICARE INSURANCE COMPANY
WI=========019OtherANTHEM BLUE CROSS BLUE SHIELD
WI42121000Medicaid