Healthcare Provider Details

I. General information

NPI: 1568310399
Provider Name (Legal Business Name): UNITY MENTAL HEALTH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 DEVELOPMENT DR
GREEN BAY WI
54311-4246
US

IV. Provider business mailing address

1041 MAIN AVE # 665
DE PERE WI
54115-1307
US

V. Phone/Fax

Practice location:
  • Phone: 920-600-9949
  • Fax:
Mailing address:
  • Phone: 414-465-9708
  • Fax: 414-465-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PAKOU THAO
Title or Position: CLINICAL THERAPIST
Credential:
Phone: 920-600-9949