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General NPI Number Information
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NPI Number | 1538790324
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Entity Type | Organization
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Legal Business Name | OOBOODASH CARES WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 10576 MAIN STREET
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City | HAYWARD
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State | WI
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Zip | 54843-6658
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Country | US
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Telephone | 715-699-0026
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Fax | 715-934-2101
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Provider Business Mailing Address
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Address Line | PO BOX 504
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City | HAYWARD
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State | WI
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Zip | 54843-0504
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Country | US
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Telephone | 715-699-0026
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Fax | 715-934-2101
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | SARAH A CORMELL
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Credential | LCSW SAC
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Telephone | 715-699-0026
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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 |
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License Number State |
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