| County Of Green Lake | |
|
571 County Road A Green Lake WI 54941 | |
| (920) 294-4070 | |
| (920) 294-4139 |
| Full Name | County Of Green Lake |
|---|---|
| Speciality | Counselor |
| Location | 571 County Road A, Green Lake, Wisconsin |
| Authorized Official Name and Position | Jason N. Jerome (DIRECTOR) |
| Authorized Official Contact | 9202944070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| County Of Green Lake 571 County Road A Green Lake WI 54941-8630 Ph: (920) 294-4070 | County Of Green Lake 571 County Road A Green Lake WI 54941 Ph: (920) 294-4070 |
| NPI Number | 1780867408 |
|---|---|
| Provider Enumeration Date | 12/17/2007 |
| Last Update Date | 07/03/2018 |
| Medicare PECOS PAC ID | 6507881265 |
|---|---|
| Medicare Enrollment ID | O20051011001149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780867408 | NPI | - | NPPES |
| 42139800 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Linda A Diraimondo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821159138 PECOS PAC ID: 4284528266 Enrollment ID: I20040422000671 |
| Provider Name | Jason Lee Fairweather |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689278590 PECOS PAC ID: 2466804075 Enrollment ID: I20240119000724 |
| Provider Name | Lana Kay Hilbert |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811105851 PECOS PAC ID: 4880046218 Enrollment ID: I20240122000682 |
| Provider Name | Breana Jean Seuffer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083274534 PECOS PAC ID: 1355794736 Enrollment ID: I20240201002540 |
| Provider Name | Nichol Jean Wienkes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639545023 PECOS PAC ID: 0345683389 Enrollment ID: I20240207001598 |
| Provider Name | Brooke Danielle Zank |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700388782 PECOS PAC ID: 3375986268 Enrollment ID: I20240207003361 |
York Behavioral Health Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 477 Golf Hill Ct, Green Lake, WI 54941 Phone: 954-512-0351 |