Healthcare Provider Details

I. General information

NPI: 1902069776
Provider Name (Legal Business Name): PEACE TREE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CHIEFTAIN STREET SUITE B
OSCEOLA WI
54020-0816
US

IV. Provider business mailing address

PO BOX 817
OSCEOLA WI
54020-0816
US

V. Phone/Fax

Practice location:
  • Phone: 715-417-3241
  • Fax: 715-417-3243
Mailing address:
  • Phone: 715-755-2233
  • Fax: 715-755-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2792
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DOWNING
Title or Position: CLINIC DIRECTOR
Credential: LMFT
Phone: 715-417-3241