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General NPI Number Information
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NPI Number | 1487052494
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Entity Type | Organization
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Legal Business Name | GUIDED PATH COUNSELING, LLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 641 MONROE ST SUITE 111
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City | SHEBOYGAN FALLS
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State | WI
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Zip | 53085-1358
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Country | US
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Telephone | 920-627-2793
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Fax | 920-550-0014
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Provider Business Mailing Address
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Address Line | 641 MONROE ST SUITE 111
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City | SHEBOYGAN FALLS
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State | WI
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Zip | 53085-1358
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Country | US
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Telephone | 920-627-2793
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Fax | 920-550-0014
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Authorized Official
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Title or Position | OWNER
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Name | RYAN MATTHEW GROH
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Credential | LPC, M.A.
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Telephone | 920-627-2793
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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 | 4834-125
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License Number State | WI
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