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General NPI Number Information
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NPI Number | 1174968580
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Entity Type | Organization
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Legal Business Name | MARK JUERGENS COUNSELING, LLC
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 4330 GOLF TERRACE SUITE 214
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-833-2121
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Fax | 715-833-2131
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Provider Business Mailing Address
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Address Line | 4330 GOLF TERRACE SUITE 214
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-833-2121
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Fax | 715-833-2131
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK JUERGENS
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Credential | LCSW, LPC
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Telephone | 715-833-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 3265123
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License Number State | WI
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