| NPI | 1538417035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH PETROSKEY Adminstrator 715-420-1201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 4346-125) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1331-132) | |
| 101YM0800X Counselor, Mental Health (Licence: WI 2780-125) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-09-20 |