Healthcare Provider Details

I. General information

NPI: 1730967290
Provider Name (Legal Business Name): CARE AND COMPASSION COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E LONGVIEW DR STE C
APPLETON WI
54911-2102
US

IV. Provider business mailing address

420 E LONGVIEW DR STE C
APPLETON WI
54911-2102
US

V. Phone/Fax

Practice location:
  • Phone: 920-815-3355
  • Fax: 920-239-6067
Mailing address:
  • Phone: 920-815-3355
  • Fax: 920-239-6067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLI WALDRON
Title or Position: OWNER, THERAPIST
Credential: MS, LPC
Phone: 920-815-3355