Individual
PRABHU VENKATARAMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC-IT
Contact information
Practice address
1807 N CENTER ST STE 204, BEAVER DAM, WI 53916-1005
(920) 887-8751
Mailing address
420 ELLIS ST, FOND DU LAC, WI 54935-5211
(309) 573-5154
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8241-226
WI
Other
Enumeration date
01/08/2025
Last updated
01/08/2025
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