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General NPI Number Information
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NPI Number | 1639405996
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Entity Type | Organization
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Legal Business Name | INFINITE RELATIONSHIPS LLC
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 951 KIMBALL LN STE 206
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City | VERONA
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State | WI
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Zip | 53593-1786
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Country | US
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Telephone | 608-848-8000
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Fax | 608-845-1335
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Provider Business Mailing Address
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Address Line | 951 KIMBALL LN STE 206
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City | VERONA
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State | WI
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Zip | 53593-1786
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Country | US
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Telephone | 608-848-8000
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Fax | 608-845-1335
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. DONALD D FERGUSON
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Credential | PH.D.
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Telephone | 608-848-8000
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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 | 1376-057
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License Number State | WI
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