| Full Potential Coaching Counseling Consulting Of Wi, Llc | |
|
4710 E Broadway Suite 135 Madison WI 53716-4103 | |
| (608) 205-2294 | |
| (608) 719-5033 |
| Full Name | Full Potential Coaching Counseling Consulting Of Wi, Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 4710 E Broadway, Madison, Wisconsin |
| Authorized Official Name and Position | Ted Izydor (OWNER) |
| Authorized Official Contact | 6082052294 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Potential Coaching Counseling Consulting Of Wi, Llc 4710 E Broadway Suite 135 Madison WI 53716-4103 Ph: (608) 205-2294 | Full Potential Coaching Counseling Consulting Of Wi, Llc 4710 E Broadway Suite 135 Madison WI 53716-4103 Ph: (608) 205-2294 |
| NPI Number | 1528507605 |
|---|---|
| Provider Enumeration Date | 02/22/2017 |
| Last Update Date | 02/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528507605 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 14034 (Wisconsin) | Primary |
| 101YP2500X | Counselor - Professional | 2878 (Wisconsin) | Secondary |
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