Individual
MR. THEODORE JOHN EAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS.MFT
Contact information
Practice address
108 W 2ND ST N, LADYSMITH, WI 54848-1338
(715) 532-9771
(715) 532-9774
Mailing address
W7163 DEERTAIL RD, LADYSMITH, WI 54848-9344
(715) 403-1688
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3364-123
WI
106H00000X
Marriage & Family Therapist
235-124
WI
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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