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General NPI Number Information
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NPI Number | 1417581083
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Entity Type | Organization
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Legal Business Name | RESILIENCE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 02/23/2020
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Last Update Date | 02/23/2020
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Provider Practice Location Address
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Address Line | 537 W MAIN ST STE 205
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-2879
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Country | US
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Telephone | 608-216-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 911 KATHERINE DR
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-2467
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Country | US
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Telephone | 608-216-1313
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | JONATHAN TRIGGS
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Credential | LPC
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Telephone | 608-216-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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