Provider Demographics
NPI:1164568879
Name:AFFILIATED COUNSELING CENTER, INC
Entity type:Organization
Organization Name:AFFILIATED COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-887-8751
Mailing Address - Street 1:1807 N CENTER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1005
Mailing Address - Country:US
Mailing Address - Phone:920-887-8751
Mailing Address - Fax:920-887-3977
Practice Address - Street 1:1807 N CENTER ST STE 204
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1005
Practice Address - Country:US
Practice Address - Phone:920-887-8751
Practice Address - Fax:920-887-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42187100Medicaid