Healthcare Provider Details

I. General information

NPI: 1619042199
Provider Name (Legal Business Name): LIVING WELL COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 W BROADWAY STE 201
MONONA WI
53713-1828
US

IV. Provider business mailing address

1532 W BROADWAY STE 201
MONONA WI
53713-1828
US

V. Phone/Fax

Practice location:
  • Phone: 608-223-1506
  • Fax: 608-223-1745
Mailing address:
  • Phone: 608-223-1506
  • Fax: 608-223-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH SUE MARKS
Title or Position: CLINIC DIRECTOR
Credential: LMFT
Phone: 608-223-1506