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General NPI Number Information
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NPI Number | 1649354077
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Entity Type | Organization
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Legal Business Name | WELLNESS COUNSELING CENTER, L.L.C.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 103 W COLLEGE AVE SUITE 815
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City | APPLETON
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State | WI
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Zip | 54911-5770
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Country | US
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Telephone | 920-733-1992
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Fax | 920-733-1866
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Provider Business Mailing Address
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Address Line | 103 W COLLEGE AVE SUITE 815
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City | APPLETON
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State | WI
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Zip | 54911-5770
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Country | US
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Telephone | 920-733-1992
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Fax | 920-733-1866
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Authorized Official
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Title or Position | PARTNER/PSYCHO THERAPIST
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Name | CARY BACKENGER
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Credential | MS,CADAIII,CEDS,LPC
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Telephone | 920-733-1992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1982
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License Number State | WI
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