Organization
YOUR GENX THERAPIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA DOUGLAS MS, LPC (OWNER)
(818) 208-4774
Entity
Organization
Contact information
Practice address
4539 WOODGATE DR STE D, JANESVILLE, WI 53546-8205
(818) 208-4774
Mailing address
4348 E PIC A DILLY DR, JANESVILLE, WI 53546-9681
(818) 468-8276
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
05/23/2024
Last updated
03/10/2026
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