MEDICARE: GUIDING WATERS COUNSELING 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	:	1972198240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING WATERS COUNSELING LLC

Provider Business Mailing Address
First Line	:	20 E MILWAUKEE ST STE 308
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3061
Country	:	US
Telephone Number	:	608-371-7313
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 E MILWAUKEE ST STE 308
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3061
Country	:	US
Telephone Number	:	608-371-7313
Fax Number	:	608-716-3138

Authorized Official
Title or Position	:	COUNSELOR
Name	:	LACY JO POSSELT
Credential	:	BS, MS, LPC
Telephone Number	:	608-371-7313

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	07/30/2021

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