| St. Croix Tribal Behavioral Health Clinic | |
|
4404 State Road 70 Webster WI 54893-9251 | |
| (877) 455-1901 | |
| (715) 349-8528 |
| Full Name | St. Croix Tribal Behavioral Health Clinic |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 4404 State Road 70, Webster, Wisconsin |
| Authorized Official Name and Position | Karie Taylor (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 7153498554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Croix Tribal Behavioral Health Clinic 4404 State Road 70 Webster WI 54893-9251 Ph: (877) 455-1901 | St. Croix Tribal Behavioral Health Clinic 4404 State Road 70 Webster WI 54893-9251 Ph: (877) 455-1901 |
| NPI Number | 1346233350 |
|---|---|
| Provider Enumeration Date | 08/24/2005 |
| Last Update Date | 03/27/2024 |
| Certification Date | 03/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346233350 | NPI | - | NPPES |
| 42220400 | Medicaid | WI | |
| 1831170091 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 2217 (Wisconsin) | Primary |
| 101YM0800X | Counselor - Mental Health | 2217 (Wisconsin) | Secondary |