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General NPI Number Information
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NPI Number | 1285162016
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Entity Type | Organization
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Legal Business Name | MENDING MINDS COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 05/24/2017
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Provider Practice Location Address
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Address Line | 1370 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4636
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Country | US
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Telephone | 920-420-3188
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Fax |
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Provider Business Mailing Address
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Address Line | 3155 HAYWARD AVE
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City | OSHKOSH
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State | WI
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Zip | 54904-7446
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Country | US
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Telephone | 920-420-3188
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH COUNSELOR
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Name | SHARON A HANSEN
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Credential | MSE
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Telephone | 920-420-3188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 34629
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2937-226
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License Number State | WI
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