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General NPI Number Information
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NPI Number | 1336319516
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Entity Type | Organization
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Legal Business Name | BIRCH SPRINGS COUNSELING EAST
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 6320 MONONA DR SUITE 312
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City | MONONA
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State | WI
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Zip | 53716-3952
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Country | US
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Telephone | 608-235-3546
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Fax | 608-839-0435
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Provider Business Mailing Address
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Address Line | 6320 MONONA DR SUITE 312
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City | MONONA
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State | WI
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Zip | 53716-3952
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Country | US
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Telephone | 608-235-3546
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Fax | 608-839-0435
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Authorized Official
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Title or Position | OWNER
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Name | KAITLYN ANN LAURIE
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Credential | MS LPC
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Telephone | 608-235-3546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1915125
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License Number State | WI
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