Healthcare Provider Details

I. General information

NPI: 1982947602
Provider Name (Legal Business Name): VALLEY COUNSELING & CLINICAL PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 CREST VIEW DR SUITE 2D
HUDSON WI
54016-9494
US

IV. Provider business mailing address

1810 CREST VIEW DR SUITE 2D
HUDSON WI
54016-9494
US

V. Phone/Fax

Practice location:
  • Phone: 715-781-8970
  • Fax: 715-377-0010
Mailing address:
  • Phone: 715-781-8970
  • Fax: 715-377-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5021-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4899-125
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4971-125
License Number StateWI

VIII. Authorized Official

Name: LINDSAY KJOLSING SATHER
Title or Position: LICENSED PROFESSIONAL COUNSLOR
Credential: LPC
Phone: 715-781-8970