| NPI | 1770806259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE DECKER Member 608-256-5115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: WI 1916) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2024-03-19 |