| NPI | 1215146907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY CHARLES EVANS Licensed Psychologist, Owner 715-849-3988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WI 2027) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |