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General NPI Number Information
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NPI Number | 1871057570
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Entity Type | Organization
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Legal Business Name | GENUINE WAY FAMILY THERAPY LLC
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Dates
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Enumeration Date | 01/27/2019
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Last Update Date | 01/27/2019
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Provider Practice Location Address
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Address Line | 306 S BARSTOW ST STE 109
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2622
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Country | US
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Telephone | 715-737-9222
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Fax |
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Provider Business Mailing Address
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Address Line | E9974 370TH AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5093
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Country | US
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Telephone | 715-737-9222
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Fax |
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | MRS. KARAH SUE GONSTEAD
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Credential | MSW, LCSW
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Telephone | 715-737-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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