=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922622471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIED MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2020
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1334 HOSFORD ST STE B
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54016-9230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-808-0795
-----------------------------------------------------
Fax | 715-808-0361
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1334 HOSFORD ST STE B
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54016-9230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-808-0795
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER/PARTNER
-----------------------------------------------------
Name | AUDREY NEVINS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 715-808-0795
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------