Healthcare Provider Details

I. General information

NPI: 1477544732
Provider Name (Legal Business Name): MENTAL HEALTH SERVICE FOR WOMEN AND FAMILIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 HILL ST #160
MADISON WI
53705-3542
US

IV. Provider business mailing address

715 HILL ST #160
MADISON WI
53705-3542
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-0942
  • Fax: 608-221-1143
Mailing address:
  • Phone: 608-256-0942
  • Fax: 608-221-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number24-124
License Number StateWI

VIII. Authorized Official

Name: NANCY F. YOUNG
Title or Position: OWNER/THERAPIST
Credential: M.A., MFT
Phone: 608-221-4030