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General NPI Number Information
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NPI Number | 1134201593
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Entity Type | Organization
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Legal Business Name | WISCONSIN PSYCHOTHERAPY AND HEALING CENTER, INC.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 6401 ODANA RD STE 13
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City | MADISON
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State | WI
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Zip | 53719-1126
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Country | US
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Telephone | 608-288-8022
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Fax | 608-288-8977
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Provider Business Mailing Address
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Address Line | 6401 ODANA RD STE 13
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City | MADISON
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State | WI
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Zip | 53719-1126
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Country | US
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Telephone | 608-288-8022
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Fax | 608-288-8977
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JOLIEN CONNOR
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Credential | PHD
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Telephone | 202-641-3750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2000
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License Number State | WI
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