| Life Adventure Therapies, Llc | |
|
11501 N Port Washington Rd Suite G-30 Mequon WI 53092-3465 | |
| (262) 241-9881 | |
| (262) 365-0651 |
| Full Name | Life Adventure Therapies, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 11501 N Port Washington Rd, Mequon, Wisconsin |
| Authorized Official Name and Position | Melissa J Summerfield (CO-OWNER-PSYCHOTHERAPIST) |
| Authorized Official Contact | 2622419881 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Adventure Therapies, Llc 224 Butternut St West Bend WI 53095-4910 Ph: (262) 241-9881 | Life Adventure Therapies, Llc 11501 N Port Washington Rd Suite G-30 Mequon WI 53092-3465 Ph: (262) 241-9881 |
| NPI Number | 1245254788 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245254788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 761-125 (Wisconsin) | Primary |
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