| NPI | 1700018389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LEE VELISSARIS Owner 920-364-9078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: WI 3876125) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WI 3876125) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2016-04-07 |