| NPI | 1114342441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY PERRY Administrator 608-755-5260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: WI 1265) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health (Licence: WI 1265) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: WI 1265) | |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |