| Lake Country Therapy | |
|
354 Cottonwood Ave Ste C Hartland WI 53029-2011 | |
| (262) 290-3163 | |
| Not Available |
| Full Name | Lake Country Therapy |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 354 Cottonwood Ave Ste C, Hartland, Wisconsin |
| Authorized Official Name and Position | Nicole Drake (OWNER) |
| Authorized Official Contact | 4144055067 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Country Therapy N8263 Woody Ln Ixonia WI 53036 Ph: (414) 405-5067 | Lake Country Therapy 354 Cottonwood Ave Ste C Hartland WI 53029-2011 Ph: (262) 290-3163 |
| NPI Number | 1962157826 |
|---|---|
| Provider Enumeration Date | 02/18/2022 |
| Last Update Date | 04/06/2022 |
| Certification Date | 02/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962157826 | NPI | - | NPPES |
| 1780223073 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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