| J R Thering, Llc | |
|
1245 Cheyenne Ave Ste 104 Grafton WI 53024-9323 | |
| (262) 618-2832 | |
| (262) 293-9777 |
| Full Name | J R Thering, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1245 Cheyenne Ave Ste 104, Grafton, Wisconsin |
| Authorized Official Name and Position | Dawn Liberski (CONTRACTOR AND CREDENTIALOR) |
| Authorized Official Contact | 4144268910 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J R Thering, Llc 1245 Cheyenne Ave Ste 104 Grafton WI 53024-9323 Ph: (262) 618-2832 | J R Thering, Llc 1245 Cheyenne Ave Ste 104 Grafton WI 53024-9323 Ph: (262) 618-2832 |
| NPI Number | 1700637246 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 04/01/2024 |
| Certification Date | 04/01/2024 |
| Medicare PECOS PAC ID | 1850739590 |
|---|---|
| Medicare Enrollment ID | O20240401002223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700637246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jessica R Thering |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932590916 PECOS PAC ID: 8921446667 Enrollment ID: I20240401002293 |
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