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General NPI Number Information
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NPI Number | 1255953923
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Entity Type | Organization
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Legal Business Name | HEALING RELATIONSHIPS LLC
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 150 MILLER ST
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City | JUNEAU
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State | WI
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Zip | 53039-1320
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Country | US
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Telephone | 920-214-3733
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Fax | 920-267-4027
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Provider Business Mailing Address
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Address Line | 150 MILLER ST
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City | JUNEAU
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State | WI
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Zip | 53039-1320
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Country | US
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Telephone | 920-214-3733
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Fax | 920-267-4027
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JOY ELAINE WAGNER
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Credential | LMFT
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Telephone | 920-214-3733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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