| Holistic Counseling Services, Llc | |
|
1517 Huebbe Parkway Ste A Beloit WI 53511 | |
| (608) 291-5891 | |
| (608) 713-9040 |
| Full Name | Holistic Counseling Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1517 Huebbe Parkway, Beloit, Wisconsin |
| Authorized Official Name and Position | Jackie Lynn Miller (OWNER) |
| Authorized Official Contact | 6082915891 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holistic Counseling Services, Llc 1517 E Huebbe Pkwy Ste A Beloit WI 53511-1795 Ph: (608) 291-5891 | Holistic Counseling Services, Llc 1517 Huebbe Parkway Ste A Beloit WI 53511 Ph: (608) 291-5891 |
| NPI Number | 1033773734 |
|---|---|
| Provider Enumeration Date | 04/28/2019 |
| Last Update Date | 04/09/2020 |
| Certification Date | 04/09/2020 |
| Medicare PECOS PAC ID | 4880089085 |
|---|---|
| Medicare Enrollment ID | O20220325001452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033773734 | NPI | - | NPPES |
| 100096899 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Briann N Modos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396391728 PECOS PAC ID: 7618206202 Enrollment ID: I20190906001885 |
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