| New Depth Counseling & Wellness Services, Llc | |
|
1345 W Mason St Ste 102 Green Bay WI 54303-2049 | |
| (920) 301-3546 | |
| (920) 301-3400 |
| Full Name | New Depth Counseling & Wellness Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1345 W Mason St Ste 102, Green Bay, Wisconsin |
| Authorized Official Name and Position | Lisa Shaw (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9203013546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Depth Counseling & Wellness Services, Llc N6921 Woodside Hills Dr Sheboygan WI 53083-1681 Ph: (920) 980-0316 | New Depth Counseling & Wellness Services, Llc 1345 W Mason St Ste 102 Green Bay WI 54303-2049 Ph: (920) 301-3546 |
| NPI Number | 1376250795 |
|---|---|
| Provider Enumeration Date | 11/04/2022 |
| Last Update Date | 11/23/2022 |
| Certification Date | 11/23/2022 |
| Medicare PECOS PAC ID | 3476923756 |
|---|---|
| Medicare Enrollment ID | O20221230002447 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376250795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Lisa Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629176938 PECOS PAC ID: 3476635194 Enrollment ID: I20080201000507 |
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