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Behavioral Health & Social Service Providers Counselor Professional

Provider NPI: 1487840765

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
1320 MENDOTA ST STE 120  MADISON, WI 53714-1060 US
Tel: 608-280-3180  Fax: --

Business Mailing Address:
25 KESSEL CT STE 105  MADISON, WI 53711-6227 US
Tel: 608-280-3180  Fax: --

NPI Information:
NPI: 1487840765
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101YP2500XBehavioral Health & Social Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 101YP2500X





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