| 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 |