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General NPI Number Information
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NPI Number | 1477380046
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Entity Type | Organization
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Legal Business Name | ABIDE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 707 W MORELAND BLVD STE 7
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City | WAUKESHA
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State | WI
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Zip | 53188-2400
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Country | US
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Telephone | 262-393-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 E ENTERPRISE AVE STE 333
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City | APPLETON
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State | WI
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Zip | 54913-7889
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH JOHNSON
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Credential | LMFT
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Telephone | 262-364-8720
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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 |
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License Number State |
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