Organization
HERGERT & GAZINAO FAMILY COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA RAE HERGERT (CLINICAL THERAPIST)
(715) 384-7579
Entity
Organization
Contact information
Practice address
252 S CENTRAL AVE, STE #21, MARSHFIELD, WI 54449-2843
(715) 384-7579
Mailing address
PO BOX 887, MARSHFIELD, WI 54449-0887
(715) 384-7579
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1802
WI
101YM0800X
Mental Health Counselor
Primary
2669
WI
101YM0800X
Mental Health Counselor
3557
WI
101YM0800X
Mental Health Counselor
6991
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
422-45000
—
WI
Enumeration date
07/16/2007
Last updated
07/16/2007
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