Healthcare Provider Details

I. General information

NPI: 1093635831
Provider Name (Legal Business Name): COURAGEOUS HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 S COMMERCIAL ST
NEENAH WI
54956-4664
US

IV. Provider business mailing address

1416 S COMMERCIAL ST
NEENAH WI
54956-4664
US

V. Phone/Fax

Practice location:
  • Phone: 920-212-8898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN HUMISTON
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 920-212-8898