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General NPI Number Information
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NPI Number | 1639395460
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Entity Type | Individual
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Provider Name | TERA REICHELT LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 619 RIVER ST STE F
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City | BELLEVILLE
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State | WI
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Zip | 53508-9117
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Country | US
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Telephone | 608-424-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 717 ROBY RD
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City | STOUGHTON
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State | WI
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Zip | 53589-1337
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Country | US
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Telephone | 608-220-8380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 707-124
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License Number State | WI
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