Healthcare Provider Details

I. General information

NPI: 1811407059
Provider Name (Legal Business Name): ENIGMA PSYCHOLOGICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E LINCOLN AVE STE 3
FALL CREEK WI
54742-9526
US

IV. Provider business mailing address

PO BOX 80
FALL CREEK WI
54742-0080
US

V. Phone/Fax

Practice location:
  • Phone: 715-491-7370
  • Fax: 715-598-6222
Mailing address:
  • Phone: 715-461-7370
  • Fax: 715-598-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. RUSSELL GIRARD
Title or Position: PRESIDENT
Credential: MS LPC
Phone: 715-491-7370