Healthcare Provider Details

I. General information

NPI: 1538684121
Provider Name (Legal Business Name): WISCONSIN THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ENTERPRISE LN STE 130
MADISON WI
53719-1143
US

IV. Provider business mailing address

PO BOX 14421
MADISON WI
53708-0421
US

V. Phone/Fax

Practice location:
  • Phone: 608-819-8800
  • Fax: 608-819-8899
Mailing address:
  • Phone: 608-819-8800
  • Fax: 608-819-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2414-12
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUCINDA C THIMM-JURADO
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 608-819-8800