| Wolf Larson Enterprises Llc | |
|
1932 Deer Ln Washington IL 61571-9679 | |
| (309) 208-1288 | |
| Not Available |
| Full Name | Wolf Larson Enterprises Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1932 Deer Ln, Washington, Illinois |
| Authorized Official Name and Position | James Gibb (OWNER) |
| Authorized Official Contact | 3092081288 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wolf Larson Enterprises Llc 1932 Deer Ln Washington IL 61571-9679 Ph: (309) 208-1288 | Wolf Larson Enterprises Llc 1932 Deer Ln Washington IL 61571-9679 Ph: (309) 208-1288 |
| NPI Number | 1487151130 |
|---|---|
| Provider Enumeration Date | 04/10/2018 |
| Last Update Date | 04/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487151130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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