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General NPI Number Information
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NPI Number | 1750007290
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Entity Type | Organization
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Legal Business Name | SILVER MAPLE EQUINE THERAPY
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 3741 WI-138
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City | STOUGHTON
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State | WI
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Zip | 53575
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Country | US
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Telephone | 608-293-0744
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Fax | 608-873-1929
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Provider Business Mailing Address
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Address Line | 538 HUBBELL STREET
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City | MARSHALL
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State | WI
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Zip | 53559
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Country | US
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Telephone | 608-293-0744
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Fax | 608-873-1929
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | JAMES BENKARD
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Credential | LCSW, CSAC
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Telephone | 608-469-8170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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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