Provider Demographics
NPI:1235779240
Name:CONSCIOUS PRACTICE, LLC
Entity Type:Organization
Organization Name:CONSCIOUS PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:608-406-4477
Mailing Address - Street 1:505 KING ST STE 218
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4289
Mailing Address - Country:US
Mailing Address - Phone:608-406-4477
Mailing Address - Fax:
Practice Address - Street 1:119 19TH ST N
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3724
Practice Address - Country:US
Practice Address - Phone:608-406-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty