Healthcare Provider Details

I. General information

NPI: 1255860912
Provider Name (Legal Business Name): APPLETON COUNSELING MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 S NICOLET RD.
APPLETON WI
54914
US

IV. Provider business mailing address

477 S NICOLET RD
APPLETON WI
54914-8270
US

V. Phone/Fax

Practice location:
  • Phone: 920-882-6610
  • Fax: 920-882-6611
Mailing address:
  • Phone: 920-882-6610
  • Fax: 920-882-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RYAN JOSEPH ROHDE
Title or Position: COO
Credential:
Phone: 715-281-0612