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General NPI Number Information
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NPI Number | 1396541942
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Entity Type | Organization
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Legal Business Name | EQUIPOISE PROFESSIONAL COUNSELING AND PERSONAL COACHING, LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1208 S MONROE AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-3002
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Country | US
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Telephone | 920-327-2596
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 S MONROE AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-3002
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Country | US
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Telephone | 920-327-2596
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | DAVID W PALUCH
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Credential | RN (BSN) LPC (MS)
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Telephone | 920-327-2596
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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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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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