Healthcare Provider Details

I. General information

NPI: 1598404816
Provider Name (Legal Business Name): ANCHORTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 04/17/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6232 BANKERS RD LOWER
MOUNT PLEASANT WI
53403-9747
US

IV. Provider business mailing address

6232 BANKERS RD LOWR
MOUNT PLEASANT WI
53403-9747
US

V. Phone/Fax

Practice location:
  • Phone: 605-641-0566
  • Fax:
Mailing address:
  • Phone: 605-641-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA L AIELLO
Title or Position: THERAPIST/OWNER
Credential: LPC
Phone: 605-641-0566