| Monarch Behavioral Health Center Llc | |
|
4706 Cottage Grove Rd Ste 300 Madison WI 53716-1354 | |
| (608) 381-3687 | |
| (608) 501-1211 |
| Full Name | Monarch Behavioral Health Center Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4706 Cottage Grove Rd Ste 300, Madison, Wisconsin |
| Authorized Official Name and Position | Lora I Hudson (OWNER/THERAPIST) |
| Authorized Official Contact | 6083813687 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Monarch Behavioral Health Center Llc 2942 N 24th St Ste 109 Phoenix AZ 85016-7849 Ph: (608) 381-3687 | Monarch Behavioral Health Center Llc 4706 Cottage Grove Rd Ste 300 Madison WI 53716-1354 Ph: (608) 381-3687 |
| NPI Number | 1497380505 |
|---|---|
| Provider Enumeration Date | 03/09/2020 |
| Last Update Date | 10/22/2024 |
| Certification Date | 10/22/2024 |
| Medicare PECOS PAC ID | 7315362548 |
|---|---|
| Medicare Enrollment ID | O20200805002717 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497380505 | NPI | - | NPPES |
| 1942602040 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lora Hudson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942602040 PECOS PAC ID: 0941511901 Enrollment ID: I20150617000553 |
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