Organization Name: | CENTER FOR LIFE & LOSS INTEGRATION |
NPI Number: | 1073780961 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUDITH F. KOEPPL (DIRECTOR) |
Mailing Address: | 4123 Monona Dr Monona |
State: | WI US |
Postal Code: | 537161661 |
Phone Number: | 6082587771 |
Fax Number: | 6088326486 |
NPI Enumeration Date: | 05/11/2008 |
NPI Last Update Date: | 05/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 1842123 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |