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General NPI Number Information
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NPI Number | 1366362055
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Entity Type | Organization
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Legal Business Name | FVATP INTEGRATED SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 4 N SYSTEMS DR
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City | APPLETON
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State | WI
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Zip | 54914-6402
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Country | US
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Telephone | 920-205-0475
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Fax |
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Provider Business Mailing Address
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Address Line | 4 N SYSTEMS DR
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City | APPLETON
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State | WI
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Zip | 54914-6402
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Country | US
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Telephone | 920-205-0475
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACI FERG
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Credential | BCBA
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Telephone | 920-205-0475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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