Provider Demographics
NPI:1871713628
Name:EXODUS COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:EXODUS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:414-964-4357
Mailing Address - Street 1:5800 NORTH BAYSHORE DR
Mailing Address - Street 2:SUITE B 204
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-964-4357
Mailing Address - Fax:414-964-4327
Practice Address - Street 1:5800 NORTH BAYSHORE DRIVE
Practice Address - Street 2:SUITE B 204
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-964-4357
Practice Address - Fax:414-964-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WISTATE MANDATED101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty