Healthcare Provider Details

I. General information

NPI: 1992406995
Provider Name (Legal Business Name): THE COPING CORNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 ODANA RD STE 201
MADISON WI
53719-1123
US

IV. Provider business mailing address

2658 RICHARDSON ST
FITCHBURG WI
53711-5431
US

V. Phone/Fax

Practice location:
  • Phone: 608-609-3555
  • Fax:
Mailing address:
  • Phone: 602-881-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATIE MOORE
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 608-609-3555