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General NPI Number Information
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NPI Number | 1912280470
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Entity Type | Organization
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Legal Business Name | BIRCH TREE MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 6200 NESBITT RD
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City | FITCHBURG
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State | WI
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Zip | 53719-1949
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Country | US
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Telephone | 608-609-0139
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Fax |
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Provider Business Mailing Address
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Address Line | 6200 NESBITT RD
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City | FITCHBURG
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State | WI
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Zip | 53719-1949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | VANESSA HODGSON
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Credential |
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Telephone | 608-609-0139
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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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