Organization

Genesis Behavioral Services, Inc.

Mental Health Clinic/Center (Including Community Mental Health Center) in West Bend, WI(View on Map)

Legal Business Name

Genesis Behavioral Services, Inc.

NPI Number

1306004999

NPI Type

Organization

Enumeration Date

05/30/2008

Licenses

State

Wisconsin

License Number

1465

Contact
Information

Purpose

Mailing
Location

Address

12647 OLIVE BLVD
1626 CLARENCE COURT

City

Saint Louis
West Bend

State

MO
WI

Postal Code

63141-6393
53095

Country

US
US

Telephone Number

(414) 777-1570
(262) 338-8611

Authorized Official

Name

Pauline Ortloff

Title or Position

EXECUTIVE DIRECTOR

Telephone Number

(414) 777-1570

Identifiers

Identifier

42185921
42185900
42242221
42186000

Identifier State

WI
WI
WI
WI

Identifier Issuer

Unknown
Unknown
Unknown
Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/04/2014

Provider Address

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