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General NPI Number Information
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NPI Number | 1063693273
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Entity Type | Organization
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Legal Business Name | CHILD AND FAMILY CONSULTANTS
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 840 WILLARD DR SUITE 201
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City | GREEN BAY
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State | WI
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Zip | 54304-5204
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Country | US
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Telephone | 920-497-0788
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Fax | 920-497-0792
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Provider Business Mailing Address
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Address Line | 840 WILLARD DR SUITE 201
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City | GREEN BAY
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State | WI
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Zip | 54304-5204
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Country | US
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Telephone | 920-497-0788
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Fax | 920-497-0792
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Authorized Official
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Title or Position | OWNER/THERAPIST/PRESIDENT
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Name | CHERYL KAY ROTHERHAM
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Credential | M.S.
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Telephone | 920-497-0788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 40554-020
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License Number State | WI
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