| NPI | 1457933079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY M EBBEN Licensed Professional Counselor 920-214-5828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2021-04-23 |