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General NPI Number Information
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NPI Number | 1386187516
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE JOURNEY COUNSELING, LLC
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Dates
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Enumeration Date | 11/20/2016
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Last Update Date | 11/20/2016
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Provider Practice Location Address
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Address Line | 314 ASH ST
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City | BARABOO
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State | WI
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Zip | 53913-2507
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Country | US
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Telephone | 608-477-1484
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Fax | 608-356-2136
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Provider Business Mailing Address
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Address Line | 314 ASH ST
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City | BARABOO
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State | WI
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Zip | 53913-2507
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Country | US
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Telephone | 608-477-1484
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Fax | 608-356-2136
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRIS SOMMERFIELD
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Credential | LMFT
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Telephone | 608-477-1484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1038-124
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License Number State | WI
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