Healthcare Provider Details

I. General information

NPI: 1205428265
Provider Name (Legal Business Name): JULIE ANN BEROSIK MFT IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 1ST ST # ST270
NEW RICHMOND WI
54017-1742
US

IV. Provider business mailing address

150 W 1ST ST # ST270
NEW RICHMOND WI
54017-1742
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-4840
  • Fax: 715-254-9459
Mailing address:
  • Phone: 715-246-4840
  • Fax: 715-254-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number766-228
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: