Provider Demographics
NPI:1174968580
Name:MARK JUERGENS COUNSELING, LLC
Entity type:Organization
Organization Name:MARK JUERGENS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JUERGENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LPC
Authorized Official - Phone:715-833-2121
Mailing Address - Street 1:4330 GOLF TERRACE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-833-2121
Mailing Address - Fax:715-833-2131
Practice Address - Street 1:4330 GOLF TERRACE
Practice Address - Street 2:SUITE 214
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-833-2121
Practice Address - Fax:715-833-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3265123261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health