Provider Demographics
NPI:1073169975
Name:MENTAL HEALTH COLLECTIVE, LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEGGLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:608-445-6064
Mailing Address - Street 1:2961 YARMOUTH GREENWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5809
Mailing Address - Country:US
Mailing Address - Phone:608-445-6064
Mailing Address - Fax:608-416-1535
Practice Address - Street 1:2961 YARMOUTH GREENWAY DR STE B
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5809
Practice Address - Country:US
Practice Address - Phone:608-445-6064
Practice Address - Fax:608-416-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty