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General NPI Number Information
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NPI Number | 1952653271
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL FAMILY RESOURCES & ASSOCIATES LLC
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 2300 LINEVILLE RD STE 200
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City | GREEN BAY
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State | WI
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Zip | 54313-8859
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Country | US
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Telephone | 920-434-7457
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Fax | 920-434-7460
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Provider Business Mailing Address
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Address Line | 2300 LINEVILLE ROAD STE 201
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City | GREEN BAY
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State | WI
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Zip | 54313
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Country | US
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Telephone | 920-434-7457
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Fax | 920-434-7460
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Authorized Official
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Title or Position | OWNER/SOLO PRACTIONER
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Name | GAIL SELL
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Credential | MA LMFT
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Telephone | 920-434-7457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 610-124
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License Number State | WI
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