MEDICARE: COURAGE TO GROW COUNSELING CENTER, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467390344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURAGE TO GROW COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	1052 OAK FOREST DR STE 190
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-3705
Country	:	US
Telephone Number	:	507-884-1497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1052 OAK FOREST DR STE 190
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-3705
Country	:	US
Telephone Number	:	507-884-1497
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	ANDREA WAGNER
Credential	:	MED
Telephone Number	:	507-884-1497

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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