| NPI | 1770346702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERONICA M ELLINGWORTH Owner/Office Manager/Clinical Super 608-695-0960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2024-02-01 |
| Last Update Date | 2024-05-29 |