| Professional Services Group, Inc. | |
|
220 Washington Avenue Oshkosh WI 54903 | |
| (920) 237-6990 | |
| (920) 424-7521 |
| Full Name | Professional Services Group, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 220 Washington Avenue, Oshkosh, Wisconsin |
| Authorized Official Name and Position | Brian A Wolf (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4147272789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Services Group, Inc. 1126 S. 70th Street Suite S-507 West Allis WI 53214-3151 Ph: (414) 727-2789 | Professional Services Group, Inc. 220 Washington Avenue Oshkosh WI 54903 Ph: (920) 237-6990 |
| NPI Number | 1598080525 |
|---|---|
| Provider Enumeration Date | 04/01/2010 |
| Last Update Date | 05/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598080525 | NPI | - | NPPES |
| 000084462 | Other | WI | MEDICARE ID - TYPE UNSPECIFIED |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1749 (Wisconsin) | Secondary |
| 101YM0800X | Counselor - Mental Health | 1749 (Wisconsin) | Primary |
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