| N/a | |
|
1203 Saint Lawrence Ave Beloit WI 53511-5067 | |
| (608) 436-1727 | |
| Not Available |
| Full Name | N/a |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1203 Saint Lawrence Ave, Beloit, Wisconsin |
| Authorized Official Name and Position | Shirley Wortham (PROFESSIONAL COUNSELING) |
| Authorized Official Contact | 6084361727 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 1203 Saint Lawrence Ave Beloit WI 53511-5067 Ph: (608) 436-1727 | N/a 1203 Saint Lawrence Ave Beloit WI 53511-5067 Ph: (608) 436-1727 |
| NPI Number | 1871953216 |
|---|---|
| Provider Enumeration Date | 02/27/2016 |
| Last Update Date | 02/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871953216 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2817226 (Wisconsin) | Primary |
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