Organization
RISING HOPE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER A NICHOLS MS, LPC-IT, SAC (THERAPIST)
(608) 769-6784
Entity
Organization
Contact information
Practice address
200 MASON ST STE 11, ONALASKA, WI 54650-7061
(608) 765-5501
Mailing address
200 MASON ST STE 11, ONALASKA, WI 54650-7061
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16360-131
STATE OF WISCONSIN SAC LICENSURE
WI
01
—
4346-226
STATE OF WISCONSIN LPC LICENSURE
WI
Enumeration date
03/03/2020
Last updated
03/03/2020
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