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General NPI Number Information
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NPI Number | 1346409018
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Entity Type | Organization
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Legal Business Name | ACT XII COUNSELING AND MINISTRY, INC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 4023 N 47TH PL
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City | SHEBOYGAN
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State | WI
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Zip | 53083-2554
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Country | US
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Telephone | 920-459-8866
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Fax | 920-459-8866
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Provider Business Mailing Address
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Address Line | 4023 N 47TH PL
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City | SHEBOYGAN
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State | WI
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Zip | 53083-2554
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Country | US
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Telephone | 920-459-8866
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Fax | 920-459-8866
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MRS. JAN MARIE FRANK
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Credential |
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Telephone | 920-459-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | L025526
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License Number State | WI
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