Healthcare Provider Details

I. General information

NPI: 1982918124
Provider Name (Legal Business Name): LT RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 COUNTY ROAD R
BLACK RIVER FALLS WI
54615-5129
US

IV. Provider business mailing address

409 COUNTY ROAD R PO BOX 271
BLACK RIVER FALLS WI
54615-5129
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-9477
  • Fax: 715-284-5547
Mailing address:
  • Phone: 715-284-9477
  • Fax: 715-284-5547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number15427131
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3117125
License Number StateWI

VIII. Authorized Official

Name: LYNN LIANE HOORNSTRA
Title or Position: PSYCHOTHERAPIST
Credential: MS, LPC
Phone: 715-284-9477