Provider Demographics
NPI:1487368908
Name:BURCHBY COUNSELING INC
Entity type:Organization
Organization Name:BURCHBY COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:DANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHBY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-245-0087
Mailing Address - Street 1:N9171 CHRISTOPHER LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7089
Mailing Address - Country:US
Mailing Address - Phone:920-245-0087
Mailing Address - Fax:
Practice Address - Street 1:40 JEWELERS PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3893
Practice Address - Country:US
Practice Address - Phone:920-245-0087
Practice Address - Fax:262-208-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100165489Medicaid