Provider Demographics
NPI:1053406066
Name:NETT WORK FAMILY COUNSELING LLC
Entity type:Organization
Organization Name:NETT WORK FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-451-6908
Mailing Address - Street 1:2801 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083
Mailing Address - Country:US
Mailing Address - Phone:920-451-6908
Mailing Address - Fax:920-458-6439
Practice Address - Street 1:2801 CALUMET DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083
Practice Address - Country:US
Practice Address - Phone:920-451-6908
Practice Address - Fax:920-458-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1656261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42206900Medicaid
WI42206900Medicaid