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General NPI Number Information
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NPI Number | 1588956346
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Entity Type | Organization
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Legal Business Name | RED FEATHER THERAPY AND CONSULTING, LLC
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 2920 EAST AVENUE SOUTH SUITE 101 RED FEATHER THERAPY AND CONSULTING, LLC
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City | LACROSSE
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State | WI
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Zip | 54601-4925
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Country | US
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Telephone | 608-784-8688
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Fax | 608-784-8686
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Provider Business Mailing Address
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Address Line | 320 17TH ST S RED FEATHER THERAPY AND CONSULTING, LLC
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City | LACROSSE
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State | WI
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Zip | 54601-4925
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Country | US
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Telephone | 608-738-5261
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Fax | 608-784-8686
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Authorized Official
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Title or Position | CEO - CLINICAL SOCIAL WORKER
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Name | MR. JOHN ROBERT STREYLE
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Credential | MS, LCSW
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Telephone | 608-738-5261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2363-123
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License Number State | WI
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