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General NPI Number Information
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NPI Number | 1396944757
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Entity Type | Organization
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Legal Business Name | HERGERT & GAZINAO FAMILY COUNSELING SERVICES
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 252 S CENTRAL AVE STE #21
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City | MARSHFIELD
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State | WI
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Zip | 54449-2843
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Country | US
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Telephone | 715-384-7579
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 887
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City | MARSHFIELD
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State | WI
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Zip | 54449-0887
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Country | US
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Telephone | 715-384-7579
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MS. LISA RAE HERGERT
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Credential |
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Telephone | 715-384-7579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1802
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3557
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6991
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2669
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License Number State | WI
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