Organization
LIVING WELL MENTAL HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECCA GREUB (CLINICAL PSYCHOLOGIST)
(715) 313-4748
Entity
Organization
Contact information
Practice address
112 N CENTRAL AVE, OWEN, WI 54460
(715) 313-4748
(715) 229-0331
Mailing address
PO BOX 65, OWEN, WI 54460-0065
(715) 229-0330
(715) 229-0331
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184002560
—
WI
05
—
1548793235
—
WI
05
—
1720477182
—
WI
05
—
K400340967
—
WI
Enumeration date
04/03/2018
Last updated
08/16/2024
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