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General NPI Number Information
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NPI Number | 1003179953
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Entity Type | Organization
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Legal Business Name | THUNDERMIST, INC.
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 2108A SILVERNAIL RD SUITE 116
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City | PEWAUKEE
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State | WI
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Zip | 53072-5526
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Country | US
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Telephone | 888-468-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 2108A SILVERNAIL RD SUITE 116
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City | PEWAUKEE
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State | WI
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Zip | 53072-5526
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Country | US
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Telephone | 888-468-9981
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | SEAN B JONES
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Credential | LLC
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Telephone | 888-898-4591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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