Organization Name: | LAKEFRONT WELLNESS CENTER, SC |
NPI Number: | 1316024847 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BETH A. JOHNSON (DIRECTOR) |
Mailing Address: | 161 W Wisconsin Ave Ste 2b Pewaukee |
State: | WI US |
Postal Code: | 530723468 |
Phone Number: | 2626958857 |
Fax Number: | 2626958879 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 08/27/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2437 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |