Organization
OPAL WATERS THERAPY LLC
Active
Other names
Opal Waters Psychotherapy
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GRACE KANZENBACH LCSW (OWNER)
(608) 668-4035
Entity
Organization
Contact information
Practice address
361 FALLS RD STE 688, GRAFTON, WI 53024-2617
(608) 668-4035
Mailing address
361 FALLS RD STE 688, GRAFTON, WI 53024-2617
(608) 668-4035
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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