MEDICARE: FRESH PERSPECTIVE PSYCHOTHERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053020297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESH PERSPECTIVE PSYCHOTHERAPY LLC

Provider Business Mailing Address
First Line	:	2395 W WASHINGTON ST STE 202
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-2147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2395 W WASHINGTON ST STE 202
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-2147
Country	:	US
Telephone Number	:	262-689-9203
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	JENNIFER LAUBENSTEIN
Credential	:
Telephone Number	:	262-689-9203

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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