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General NPI Number Information
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NPI Number | 1063802445
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Entity Type | Organization
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Legal Business Name | THE THERAPY PLACE OF LA CROSSE, LLC
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 700 3RD ST N STE 202A
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City | LA CROSSE
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State | WI
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Zip | 54601-3288
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Country | US
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Telephone | 608-317-7327
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Fax |
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Provider Business Mailing Address
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Address Line | 700 3RD ST N STE 202A
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City | LA CROSSE
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State | WI
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Zip | 54601-3288
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Country | US
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Telephone | 608-317-7327
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA SUE HELLWIG-COTTRELL
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Credential | MS, LPC
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Telephone | 608-317-7327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4303-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6938-123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3447-125
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License Number State | WI
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