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General NPI Number Information
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NPI Number | 1558921874
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Entity Type | Organization
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Legal Business Name | RED MAPLE COUNSELING LLC
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 10/30/2021
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Provider Practice Location Address
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Address Line | 11017 MAIN ST
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City | HEWITT
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State | WI
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Zip | 54441-9020
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Country | US
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Telephone | 715-305-5696
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Fax |
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Provider Business Mailing Address
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Address Line | 11017 MAIN ST
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City | HEWITT
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State | WI
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Zip | 54441-9020
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Country | US
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Telephone | 715-387-1958
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Fax | 715-387-1992
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL A WUETHRICH
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Credential |
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Telephone | 715-387-1992
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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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