Healthcare Provider Details

I. General information

NPI: 1417844358
Provider Name (Legal Business Name): YOUPHORIA3, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WISCONSIN ST BLDG D02
EAU CLAIRE WI
54703-3588
US

IV. Provider business mailing address

E1750 SPRUCE RD
ELEVA WI
54738-9074
US

V. Phone/Fax

Practice location:
  • Phone: 715-529-0980
  • Fax:
Mailing address:
  • Phone: 715-529-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: CYDNEY M PETERSON
Title or Position: MANAGER
Credential:
Phone: 715-529-0980