| NPI | 1164692034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LEWIS Psychotherapist 608-257-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 3047) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1008) |
| 1041C0700X Social Worker, Clinical (Licence: WI 1105123) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2008-03-07 |