| NPI | 1003311556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAREY SORENSON Owner 920-903-8841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WI 3407-57) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2024-04-18 |