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General NPI Number Information
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NPI Number | 1699015636
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Entity Type | Organization
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Legal Business Name | MENTE SALUS PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 4319 JEFFERS RD SUITE 101
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City | EAU CLAIRE
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State | WI
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Zip | 54703-3726
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Country | US
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Telephone | 715-839-7240
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Fax | 715-839-7674
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Provider Business Mailing Address
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Address Line | 4319 JEFFERS RD SUITE 101
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City | EAU CLAIRE
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State | WI
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Zip | 54703-3726
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Country | US
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Telephone | 715-839-7240
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Fax | 715-839-7674
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Authorized Official
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Title or Position | SOLE MEMBER/LICENSED PSYCHOLOGIST
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Name | DR. NINA FRANCES ALBANESE-KOTAR
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Credential | PHD
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Telephone | 715-839-7240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2858-057
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License Number State | WI
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