| Velvaere Mental Health Clinic, Llc | |
|
100 Business Park Cir Ste 202 Stoughton WI 53589-5501 | |
| (608) 205-8308 | |
| (608) 719-3418 |
| Full Name | Velvaere Mental Health Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 Business Park Cir Ste 202, Stoughton, Wisconsin |
| Authorized Official Name and Position | Veronica M Ellingworth (OWNER/OFFICE MANAGER/CLINICAL SUPER) |
| Authorized Official Contact | 6086950960 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Velvaere Mental Health Clinic, Llc 100 Business Park Cir Ste 202 Stoughton WI 53589-5501 Ph: (608) 205-8308 | Velvaere Mental Health Clinic, Llc 100 Business Park Cir Ste 202 Stoughton WI 53589-5501 Ph: (608) 205-8308 |
| NPI Number | 1770346702 |
|---|---|
| Provider Enumeration Date | 02/01/2024 |
| Last Update Date | 05/29/2024 |
| Certification Date | 05/29/2024 |
| Medicare PECOS PAC ID | 1456893403 |
|---|---|
| Medicare Enrollment ID | O20240606001074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770346702 | NPI | - | NPPES |
| Provider Name | Veronica M Ellingworth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528577152 PECOS PAC ID: 7416397344 Enrollment ID: I20240425002866 |
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