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647 W Main St Ste 700 Lake Geneva WI 53147-1997 | |
| (262) 729-3143 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 647 W Main St Ste 700, Lake Geneva, Wisconsin |
| Authorized Official Name and Position | Christina Dame (OWNER) |
| Authorized Official Contact | 2627293143 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
647 W Main St Ste 700 Lake Geneva WI 53147-1997 Ph: (262) 729-3143 | 647 W Main St Ste 700 Lake Geneva WI 53147-1997 Ph: (262) 729-3143 |
| NPI Number | 1407442908 |
|---|---|
| Provider Enumeration Date | 12/18/2020 |
| Last Update Date | 01/30/2025 |
| Certification Date | 01/30/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407442908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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