|
| |
|
196 3rd St Fond Du Lac WI 54935-4418 | |
| (920) 733-2065 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Counseling |
| Location | 196 3rd St, Fond Du Lac, Wisconsin |
| Authorized Official Name and Position | Leslie Johnson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (704) 506-6267 | 196 3rd St Fond Du Lac WI 54935-4418 Ph: (920) 733-2065 |
| NPI Number | 1104688365 |
|---|---|
| Provider Enumeration Date | 01/24/2024 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104688365 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
Positive Clinical Concepts Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 498 Ruggles St, Fond Du Lac, WI 54935 Phone: 801-703-6192 | |
Transformative Connections Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 88 Guindon Blvd, Fond Du Lac, WI 54935 Phone: 920-318-3282 | |
Integrated Counseling Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: N6687 Wrightway Dr Ste D, Fond Du Lac, WI 54937 Phone: 920-929-9140 Fax: 920-929-9142 | |