Healthcare Provider Details

I. General information

NPI: 1083522601
Provider Name (Legal Business Name): ROOM FOR GRACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 OMRO RD
OSHKOSH WI
54904-8839
US

IV. Provider business mailing address

2937 OMRO RD
OSHKOSH WI
54904-8839
US

V. Phone/Fax

Practice location:
  • Phone: 920-279-2108
  • Fax:
Mailing address:
  • Phone: 920-279-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. AMYSUE HARTMAN
Title or Position: OWNER/MANAGING MEMBER
Credential: LPC, LPCC
Phone: 920-279-2108