Provider Demographics
NPI:1538175195
Name:SAMARITAN COUNSELING CENTER OF THE FOX VALLEY, INC.
Entity type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF THE FOX VALLEY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE & ADMINISTRATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-886-9319
Mailing Address - Street 1:1205 PROVINCE TER
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-7017
Mailing Address - Country:US
Mailing Address - Phone:920-886-9319
Mailing Address - Fax:920-486-5340
Practice Address - Street 1:1205 PROVINCE TER
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-7017
Practice Address - Country:US
Practice Address - Phone:920-886-9319
Practice Address - Fax:920-486-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1355261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42181900Medicaid