| Embodied-welllbeing | |
|
2501 Jenny Lane Green Bay WI 54302 | |
| (920) 212-7523 | |
| Not Available |
| Full Name | Embodied-welllbeing |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2501 Jenny Lane, Green Bay, Wisconsin |
| Authorized Official Name and Position | Keith Paul Neilitz (CLINICAL THERAPIST) |
| Authorized Official Contact | 9205218940 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Embodied-welllbeing 2501 Jenny Ln Apt 8 Green Bay WI 54302-5039 Ph: (920) 521-8940 | Embodied-welllbeing 2501 Jenny Lane Green Bay WI 54302 Ph: (920) 212-7523 |
| NPI Number | 1124730023 |
|---|---|
| Provider Enumeration Date | 12/22/2022 |
| Last Update Date | 11/03/2023 |
| Certification Date | 11/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124730023 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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