| NPI | 1144708942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL VENETA NICKLES Psychotherapist 608-256-5115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 2843-123) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2018-08-02 |