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General NPI Number Information
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NPI Number | 1174749725
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Entity Type | Organization
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Legal Business Name | BARABOO PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 227 5TH AVE
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City | BARABOO
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State | WI
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Zip | 53913-2116
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Country | US
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Telephone | 608-356-9066
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Fax | 608-356-9470
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Provider Business Mailing Address
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Address Line | 227 5TH AVE
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City | BARABOO
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State | WI
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Zip | 53913-2116
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Country | US
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Telephone | 608-356-9066
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Fax | 608-356-9470
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. DEBORAH JEAN MARTIN
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Credential | MS, LPC
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Telephone | 608-356-9066
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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 | 396-44-800
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License Number State | WI
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