Provider Demographics
NPI:1427596121
Name:CORAM CONSULTING LLC
Entity Type:Organization
Organization Name:CORAM CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:G
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:715-931-0317
Mailing Address - Street 1:904 N 2ND ST STE C
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-7736
Mailing Address - Country:US
Mailing Address - Phone:715-931-0317
Mailing Address - Fax:
Practice Address - Street 1:431 S MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2241
Practice Address - Country:US
Practice Address - Phone:715-931-0317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2862-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty