MEDICARE: PASTORAL & FAMILY THERAPY SERVICES

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	251S00000X	Community/Behavioral Health Agency	653-124	WI
2	251S00000X	Community/Behavioral Health Agency	2876-125	WI

General Provider Information

NPI Number	:	1992957914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASTORAL & FAMILY THERAPY SERVICES

Provider Business Mailing Address
First Line	:	162 W MAIN ST
Second Line	:	SUITE G
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1995
Country	:	US
Telephone Number	:	262-473-5005
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 W MAIN ST
Second Line	:	SUITE G
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1995
Country	:	US
Telephone Number	:	262-473-5005
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONALD MICHAEL NORMAN
Credential	:	PH.D., LPC, LMFT
Telephone Number	:	262-473-5005

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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