| NPI | 1457756595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE THOMAS Member 608-513-2272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 674124) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 222957) |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2015-05-05 |