| NPI | 1366983959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE PROROK Therapist 608-632-9176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 5504-125) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-04-27 |