| NPI | 1053009449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORICE JEAN Mental Health Therapist 262-822-6847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2025-05-30 |