Organization
WISCONSIN THERAPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCINDA THIMM-JURADO (OWNER)
(608) 833-9770
Entity
Organization
Contact information
Practice address
402 GAMMON PL STE 290, MADISON, WI 53719-1075
(608) 833-9770
(608) 833-1197
Mailing address
PO BOX 14421, MADISON, WI 53708-0421
(608) 833-9770
(608) 833-1197
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2414-12
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
08/04/2017
Last updated
08/04/2017
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