Healthcare Provider Details

I. General information

NPI: 1528320926
Provider Name (Legal Business Name): QUALITY COUNSELING AND CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 REGIS CT SUITE 210
EAU CLAIRE WI
54701-3786
US

IV. Provider business mailing address

1119 REGIS CT SUITE 120
EAU CLAIRE WI
54701-3786
US

V. Phone/Fax

Practice location:
  • Phone: 715-514-4451
  • Fax: 715-514-4453
Mailing address:
  • Phone: 715-832-0592
  • Fax: 866-436-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number747
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11318
License Number StateWI

VIII. Authorized Official

Name: MS. TAMMY M KELSER
Title or Position: OWNER
Credential: CSAC, LMFT
Phone: 715-832-0592