NPIMap

Northwest Journey - Amery

Organization Active NPI Adolescent and Children Mental Health Clinic/Center · Amery, WI

NPI 1124145370 · NPPES record last updated Sep 23, 2010

Key facts

NPI
1124145370
Entity type
Organization (NPI type 2)
Primary specialty
Adolescent and Children Mental Health Clinic/Center 261QM0855X
License
2195 (WI)
Legal business name
NORTHWEST JOURNEY - AMERY
Practice address
1096 Apple Ave
Amery, WI 54001-1707
Phone
(715) 268-5404
Fax
(715) 268-6103
NPI assigned
Mar 23, 2007
Organization subpart
Yes
Parent organization (as reported)
NORTHWEST COUNSELING AND GUIDANCE CLINIC

Authorized official

Name
Mr. Nick Kalambokisis
Title
Cfo
Phone
(715) 327-4402

Corporate family (same tax ID) 21

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Northwest Counseling Center (22 organizations share this tax ID)
Part of
Northwest Counseling Center

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2195 WI Yes

Addresses

Primary practice location

1096 Apple Ave
Amery, WI 54001-1707

Mailing address

1096 Apple Ave
Amery, WI 54001-1707
Phone (715) 268-5404

Other identifiers

IdentifierTypeStateIssuer
7H956NOOtherMNBCBS OF MN
42626OtherMNHEALTH PARTNERS
43005500MedicaidWI
85575OtherMNPREFERRED ONE

Other providers in Amery, WI

All providers in Amery, WI · Adolescent and Children Mental Health Clinic/Center in Wisconsin

Sources for this page

Verify at the official NPI Registry.