| NPI | 1528320926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY M KELSER Owner 715-832-0592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WI 747) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 11318) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2016-12-15 |