Healthcare Provider Details

I. General information

NPI: 1245951920
Provider Name (Legal Business Name): CUP OF THOUGHTS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LANCE DR UNIT 210
TWIN LAKES WI
53181-9292
US

IV. Provider business mailing address

310 LANCE DR. SUITE 210
TWIN LAKES WI
53181-9292
US

V. Phone/Fax

Practice location:
  • Phone: 608-400-4320
  • Fax:
Mailing address:
  • Phone: 608-295-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MELINDA PEDERSEN
Title or Position: OWNER
Credential: MS, LPC, NCC
Phone: 608-295-4797