| Affiliated Counseling Center, Inc | |
|
1807 N Center St Ste 204 Beaver Dam WI 53916-1005 | |
| (920) 887-8751 | |
| (920) 887-3977 |
| Full Name | Affiliated Counseling Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1807 N Center St Ste 204, Beaver Dam, Wisconsin |
| Authorized Official Name and Position | Daniel Massie (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9208878751 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Affiliated Counseling Center, Inc 1807 N Center St Ste 204 Beaver Dam WI 53916-1005 Ph: (920) 887-8751 | Affiliated Counseling Center, Inc 1807 N Center St Ste 204 Beaver Dam WI 53916-1005 Ph: (920) 887-8751 |
| NPI Number | 1164568879 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 06/26/2025 |
| Certification Date | 06/26/2025 |
| Medicare PECOS PAC ID | 5991790883 |
|---|---|
| Medicare Enrollment ID | O20040419001617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164568879 | NPI | - | NPPES |
| 42187100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Daniel J Massie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427355445 PECOS PAC ID: 9830364363 Enrollment ID: I20111213000211 |
| Provider Name | Robert Frank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447666870 PECOS PAC ID: 0648549394 Enrollment ID: I20180816000269 |
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