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General NPI Number Information
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NPI Number | 1003486523
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Entity Type | Organization
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Legal Business Name | MICHENER CHILD AND ADOLESCENT COUNSELING, LLC
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 1370 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4636
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Country | US
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Telephone | 920-268-6940
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Fax |
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Provider Business Mailing Address
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Address Line | N433 MAPLERIDGE DR
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City | APPLETON
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State | WI
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Zip | 54915-8754
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Country | US
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Telephone | 920-268-6940
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MICHELLE MICHENER
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Credential | LPC
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Telephone | 920-268-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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