Provider Demographics
NPI:1003168139
Name:YAHARA COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:YAHARA COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL LICENSED COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:608-838-7931
Mailing Address - Street 1:5203 N AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-8612
Mailing Address - Country:US
Mailing Address - Phone:608-838-7931
Mailing Address - Fax:
Practice Address - Street 1:6320 MONONA DR STE 408
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3975
Practice Address - Country:US
Practice Address - Phone:608-467-9074
Practice Address - Fax:608-467-9075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4572-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty