Jacobs Well Presbyterian Churcha

NPI #1164006573 in Green Bay, Wisconsin

Provider Information

NPI Number: 1164006573
Entity Type: Organization
Organization Name: Jacobs Well Presbyterian Churcha
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: May 11, 2021
Last Updated: May 11, 2021

Practice Location

Address: 3340 LINEVILLE RD
City: Green Bay
State: Wisconsin
ZIP Code: 54313-7237
Phone: (920) 264-9564

Authorized Official

Name: SPENCER REA HANSEN THOMAS, LPC
Title: PASTOR OF CARE AND COUNSELING
Phone: (309) 532-2364

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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