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General NPI Number Information
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NPI Number | 1326966375
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Entity Type | Organization
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Legal Business Name | AMETHYST WELLNESS LLC
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Dates
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Enumeration Date | 07/08/2026
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Last Update Date | 07/08/2026
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Provider Practice Location Address
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Address Line | 6302 ODANA RD STE 215
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City | MADISON
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State | WI
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Zip | 53719-1162
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Country | US
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Telephone | 608-709-9575
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Fax | 608-714-4010
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Provider Business Mailing Address
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Address Line | PO BOX 127
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City | MAZOMANIE
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State | WI
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Zip | 53560-0127
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Country | US
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Telephone | 608-709-9575
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Fax | 608-714-4010
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | KELLY RAUFMAN
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Credential | LCSW
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Telephone | 608-531-8578
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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