Organization
PSYCHOTHERAPY & GROWTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LAUREE SCHUTT-CHARDON (ADMINISTRATOR)
(608) 770-7792
Entity
Organization
Contact information
Practice address
660 W WASHINGTON AVE, SUITE #307, MADISON, WI 53703-4703
(608) 255-0669
(608) 255-0667
Mailing address
660 W WASHINGTON AVE, SUITE #307, MADISON, WI 53703-4703
(608) 255-0669
(608) 255-0667
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1393123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42164400
—
WI
Enumeration date
02/27/2008
Last updated
02/27/2008
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