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General NPI Number Information
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NPI Number | 1356961775
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Entity Type | Organization
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Legal Business Name | AMANDA DONATH PSYCHOLOGICAL SERVICES S C
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Dates
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Enumeration Date | 04/26/2020
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 712 SUMMIT AVE STE 714
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3827
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Country | US
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Telephone | 262-262-2006
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Fax | 262-226-2462
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Provider Business Mailing Address
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Address Line | 712 SUMMIT AVE STE 714
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3827
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Country | US
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Telephone | 262-262-2006
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Fax | 262-226-2462
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA DONATH
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Credential |
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Telephone | 262-226-2006
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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 |
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License Number State |
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