| Stateline Mental Health Services | |
|
540 E Grand Ave Beloit WI 53511-6314 | |
| (608) 368-8087 | |
| Not Available |
| Full Name | Stateline Mental Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 540 E Grand Ave, Beloit, Wisconsin |
| Authorized Official Name and Position | Stephanie Knueppel (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6082177264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stateline Mental Health Services 2745 Fawn Ct Beloit WI 53511-1973 Ph: () - | Stateline Mental Health Services 540 E Grand Ave Beloit WI 53511-6314 Ph: (608) 368-8087 |
| NPI Number | 1538560255 |
|---|---|
| Provider Enumeration Date | 09/12/2014 |
| Last Update Date | 03/14/2017 |
| Medicare PECOS PAC ID | 1658655865 |
|---|---|
| Medicare Enrollment ID | O20170308001000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538560255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Faith E Mattison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487686648 PECOS PAC ID: 1355386368 Enrollment ID: I20050621000576 |
| Provider Name | Garth E Fisher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104915248 PECOS PAC ID: 4880613231 Enrollment ID: I20051115001040 |
| Provider Name | David Malcolm Fischer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568853091 PECOS PAC ID: 4688990047 Enrollment ID: I20150302000470 |
| Provider Name | Betsy L Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194194985 PECOS PAC ID: 8325356223 Enrollment ID: I20150925001454 |
| Provider Name | Samantha J Ball |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760833099 PECOS PAC ID: 6103161104 Enrollment ID: I20181219002500 |
| Provider Name | Stephanie Sisson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982986261 PECOS PAC ID: 1951725522 Enrollment ID: I20200716000979 |
| Provider Name | Nicolette Ann Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396376851 PECOS PAC ID: 1153787544 Enrollment ID: I20230509001491 |
| Provider Name | Taylor Leibfried |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740896885 PECOS PAC ID: 1658737523 Enrollment ID: I20230518001781 |
| Provider Name | Sabrina Meichtry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396413944 PECOS PAC ID: 5991150104 Enrollment ID: I20231009000593 |
| Provider Name | Nicholas Dean Dubios-rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215540547 PECOS PAC ID: 0143676429 Enrollment ID: I20231023001646 |
| Provider Name | Victoria Mackenzie Krohn |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1225727969 PECOS PAC ID: 9436506326 Enrollment ID: I20231115000640 |
| Provider Name | Brielle Evelyn Powers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407345903 PECOS PAC ID: 6507286887 Enrollment ID: I20231117000543 |
| Provider Name | Sarah Jane Petersen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073228607 PECOS PAC ID: 7719337542 Enrollment ID: I20231220001260 |
| Provider Name | Kelley F Everson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053685602 PECOS PAC ID: 1355793795 Enrollment ID: I20240122001002 |
| Provider Name | Heidi Schildt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982055463 PECOS PAC ID: 7719330232 Enrollment ID: I20240131001592 |
| Provider Name | Jenniffer Beu |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821510595 PECOS PAC ID: 7719320613 Enrollment ID: I20240207003786 |
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