Healthcare Provider Details

I. General information

NPI: 1427790138
Provider Name (Legal Business Name): THE SIMPLICITY IN AUTHENTICITY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 E WASHINGTON AVE STE 400
MADISON WI
53703-4028
US

IV. Provider business mailing address

PO BOX 211
DEFOREST WI
53532-0211
US

V. Phone/Fax

Practice location:
  • Phone: 608-389-0253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. GABRIELA RUTH JUMP
Title or Position: PSYCHOTHERAPIST
Credential: LPC
Phone: 608-389-0253