Organization
FANNIN COUNSELING & ART THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA FANNIN MA, LPC, ATR (OWNER/COUNSELOR)
(608) 385-7559
Entity
Organization
Contact information
Practice address
129 6TH ST S, LA CROSSE, WI 54601-4153
(608) 385-7559
Mailing address
2128 MARKET ST, LA CROSSE, WI 54601-5057
(608) 385-7559
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5465-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100043611
—
WI
01
—
12772699
CAQH
WI
Enumeration date
10/24/2017
Last updated
10/24/2017
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