Provider Demographics
NPI:1073747804
Name:COUPLES & FAMILY THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:COUPLES & FAMILY THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR, LMFT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAJKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-441-1828
Mailing Address - Street 1:2217 VINE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-5863
Mailing Address - Country:US
Mailing Address - Phone:715-441-1828
Mailing Address - Fax:
Practice Address - Street 1:2217 VINE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-5863
Practice Address - Country:US
Practice Address - Phone:715-441-1828
Practice Address - Fax:888-802-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI693-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty