Individual
MR. BRODY THOMAS FANSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
121 S BRISTOL ST STE 102, SUN PRAIRIE, WI 53590-2995
(608) 285-2911
Mailing address
6408 BRIDGE RD APT 245, MONONA, WI 53713-1832
(608) 285-2911
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7151-226
WI
Other
Enumeration date
10/18/2022
Last updated
08/14/2024
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