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General NPI Number Information
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NPI Number | 1376913129
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Entity Type | Organization
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Legal Business Name | IN THE MOMENT CHILD AND FAMILY THERAPY, LLC
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 6705 WESNER RD
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City | VERONA
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State | WI
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Zip | 53593-9178
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Country | US
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Telephone | 608-620-3486
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Fax |
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Provider Business Mailing Address
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Address Line | 653 GARFIELD AVE
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City | EVANSVILLE
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State | WI
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Zip | 53536-1067
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Country | US
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Telephone | 608-436-0506
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIATOR
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Name | KATHLEEN MOFFETT HARWOOD
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Credential | MS
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Telephone | 608-436-0506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2694-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 478-228
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License Number State | WI
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