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General NPI Number Information
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NPI Number | 1457891012
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Entity Type | Organization
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Legal Business Name | VESBACH COUNSELING & ART THERAPY, LLC
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 2976 TRIVERTON PIKE DR STE 110
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City | FITCHBURG
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State | WI
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Zip | 53711-5840
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Country | US
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Telephone | 262-719-6569
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Fax |
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Provider Business Mailing Address
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Address Line | 2976 TRIVERTON PIKE DR STE 110
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City | FITCHBURG
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State | WI
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Zip | 53711-5840
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Country | US
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Telephone | 262-719-6569
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KRISTEN L. VESBACH
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Credential | MS, ATR-L, BC, LPC
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Telephone | 262-719-6569
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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 | 5219-125
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License Number State | WI
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