=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063873982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE COUNSELING CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2016
-----------------------------------------------------
Last Update Date | 03/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W SUMMIT AVE SUITE 220
-----------------------------------------------------
City | WALES
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53183-9427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-271-3255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 W SUMMIT AVE SUITE 220
-----------------------------------------------------
City | WALES
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53183-9427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-271-3255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST/OWNER
-----------------------------------------------------
Name | ERIN HARDY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 262-271-3255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 7451123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------