Provider Demographics
NPI:1265946990
Name:NEW GROWTH MENTAL HEALTH COUNSELING, LLC
Entity type:Organization
Organization Name:NEW GROWTH MENTAL HEALTH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-571-8211
Mailing Address - Street 1:5900 MONONA DR STE 312
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3561
Mailing Address - Country:US
Mailing Address - Phone:800-571-8211
Mailing Address - Fax:608-299-3888
Practice Address - Street 1:5900 MONONA DR STE 312
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3561
Practice Address - Country:US
Practice Address - Phone:800-571-8211
Practice Address - Fax:608-299-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100034468Medicaid