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General NPI Number Information
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NPI Number | 1184893752
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY & GROWTH CENTER
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 660 W WASHINGTON AVE SUITE #307
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City | MADISON
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State | WI
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Zip | 53703-4703
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Country | US
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Telephone | 608-255-0669
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Fax | 608-255-0667
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Provider Business Mailing Address
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Address Line | 660 W WASHINGTON AVE SUITE #307
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City | MADISON
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State | WI
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Zip | 53703-4703
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Country | US
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Telephone | 608-255-0669
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Fax | 608-255-0667
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIM LAUREE SCHUTT-CHARDON
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Credential |
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Telephone | 608-770-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1393123
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License Number State | WI
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