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General NPI Number Information
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NPI Number | 1528503497
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Entity Type | Organization
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Legal Business Name | ADVANCED THERAPIES LLC
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 4402 S 68TH ST STE104
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City | GREENFIELD
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State | WI
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Zip | 53220-3479
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Country | US
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Telephone | 262-506-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 4402 S. 68TH ST. STE104
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City | GREENFEILD
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State | WI
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Zip | 53220
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Country | US
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Telephone | 262-506-4050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY BETH LAYDEN
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Credential | LSW
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Telephone | 262-506-4050
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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 | 2417-123
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License Number State | WI
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