Organization
COUNSELING CONNECTION OF MEDFORD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLY J. SCHULTZ L.P.C AND SAC (OWNER AND THERAPIST)
(715) 748-4312
Entity
Organization
Contact information
Practice address
123 W STATE ST, SUITE #4, MEDFORD, WI 54451-1772
(715) 748-4312
(715) 748-4407
Mailing address
123 W STATE ST, SUITE #4, MEDFORD, WI 54451-1772
(715) 748-4312
(715) 748-4407
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
3054-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43576100
—
WI
Enumeration date
09/26/2007
Last updated
10/09/2008
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