| NPI | 1396944757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA RAE HERGERT Clinical Therapist 715-384-7579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 2669) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1802) |
| 101YM0800X Counselor, Mental Health (Licence: WI 3557) | |
| 101YM0800X Counselor, Mental Health (Licence: WI 6991) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2007-07-16 |