Provider Demographics
NPI:1679707152
Name:NAKODA COGNITIVE BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:NAKODA COGNITIVE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-332-0886
Mailing Address - Street 1:204 EAST CAPITOL DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MILWAUKEE
Mailing Address - State:WISCONSIN
Mailing Address - Zip Code:53212
Mailing Address - Country:UM
Mailing Address - Phone:414-332-0886
Mailing Address - Fax:414-332-0886
Practice Address - Street 1:204 E CAPITOL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1200
Practice Address - Country:US
Practice Address - Phone:414-332-0886
Practice Address - Fax:414-332-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty