| N/a | |
|
141 W Huron St Berlin WI 54923-1587 | |
| (920) 290-0107 | |
| Not Available |
| Full Name | N/a |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 141 W Huron St, Berlin, Wisconsin |
| Authorized Official Name and Position | Charlotte Louise Groves (LMFT) |
| Authorized Official Contact | 9202900107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 141 W Huron St Berlin WI 54923-1587 Ph: (920) 290-0107 | N/a 141 W Huron St Berlin WI 54923-1587 Ph: (920) 290-0107 |
| NPI Number | 1710153051 |
|---|---|
| Provider Enumeration Date | 05/06/2008 |
| Last Update Date | 05/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710153051 | NPI | - | NPPES |
| 42244600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 652-124 (Wisconsin) | Primary |
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