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General NPI Number Information
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NPI Number | 1306713409
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Entity Type | Organization
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Legal Business Name | CENTER STAGE THERAPY
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 702 N BLACKHAWK AVE STE 205
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City | MADISON
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State | WI
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Zip | 53705-3357
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Country | US
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Telephone | 608-301-5090
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Fax | 888-783-3165
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Provider Business Mailing Address
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Address Line | 2539 VAN HISE AVE
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City | MADISON
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State | WI
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Zip | 53705-3849
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Country | US
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Telephone |
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Fax | 888-783-3165
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Authorized Official
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Title or Position | OWNER
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Name | JODY REISS
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Credential | MS, LMFT
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Telephone | 608-301-5090
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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 |
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License Number State |
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