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General NPI Number Information
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NPI Number | 1972397917
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Entity Type | Organization
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Legal Business Name | THE GRATEFUL THERAPIST, LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1476 KENWOOD DR STE 102
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City | MENASHA
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State | WI
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Zip | 54952-1134
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Country | US
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Telephone | 920-850-5746
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Fax |
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Provider Business Mailing Address
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Address Line | 3331 N CASALOMA DR UNIT 19
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City | APPLETON
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State | WI
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Zip | 54913-6500
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Country | US
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Telephone | 920-850-5746
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TYLER M VAN ZEELAND
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Credential | LMFT
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Telephone | 920-850-5746
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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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