Organization
SPIRITED PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARENCE LEONARD BONANDER JR. LP (OWNER)
(612) 600-8431
Entity
Organization
Contact information
Practice address
376 VIOLET CIR, GRANTSBURG, WI 54840-8564
(612) 600-8431
Mailing address
PO BOX 502, GRANTSBURG, WI 54840-0502
(612) 600-8431
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
305S00000X
Point of Service
—
—
Other
Enumeration date
09/18/2019
Last updated
09/18/2019
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