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General NPI Number Information
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NPI Number | 1144531757
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Entity Type | Organization
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Legal Business Name | THE GROWING TREE COUNSELING & WELLNESS
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 140 W MAIN ST STE A
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City | WINNECONNE
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State | WI
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Zip | 54986-9409
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Country | US
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Telephone | 920-582-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 140 W MAIN ST PO BOX 486
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City | WINNECONNE
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State | WI
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Zip | 54986-9409
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Country | US
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Telephone | 920-582-4000
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Fax |
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | AUDRA A EGGUM
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Credential | MSW, LCSW
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Telephone | 920-582-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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