NPI | 1497166797 |
---|---|
Entity Type | Organization |
Authorized Contact | SHELLY LYNN KETELHUT Owner/Therapist 920-948-9787 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 4498125) |
Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: WI 15724132) |
Enumeration Date | 2014-05-08 |
Last Update Date | 2014-05-08 |