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General NPI Number Information
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NPI Number | 1740940121
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Entity Type | Organization
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Legal Business Name | FOX VALLEY COUNSELING AND DIAGNOSITICS
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 301 NICOLET BLVD
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City | NEENAH
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State | WI
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Zip | 54956-2756
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Country | US
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Telephone | 920-915-3735
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Fax |
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Provider Business Mailing Address
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Address Line | 3931 E GLORY LN
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City | APPLETON
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State | WI
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Zip | 54913-9391
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Country | US
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Telephone | 920-915-3735
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Fax |
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Authorized Official
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Title or Position | CLINICAL COUNSELOR
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Name | LISA RANDERSON
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Credential | LPC
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Telephone | 920-915-3735
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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 |
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License Number State |
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