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General NPI Number Information
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NPI Number | 1629223979
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Entity Type | Organization
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Legal Business Name | LT RESOURCES
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Dates
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Enumeration Date | 11/28/2008
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Last Update Date | 11/28/2008
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Provider Practice Location Address
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Address Line | 103 S WATER ST SUITE 6
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City | SPARTA
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State | WI
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Zip | 54656-1773
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Country | US
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Telephone | 608-366-1675
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Fax | 608-269-1692
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Provider Business Mailing Address
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Address Line | 103 S WATER ST SUITE 6
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City | SPARTA
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State | WI
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Zip | 54656-1773
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Country | US
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Telephone | 608-366-1675
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Fax | 608-269-1692
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Authorized Official
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Title or Position | OWNER
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Name | LYNN TRUOG
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Credential | LPC, MS
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Telephone | 608-366-1675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3117125
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License Number State | WI
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