Provider Demographics
NPI:1558921874
Name:RED MAPLE COUNSELING LLC
Entity Type:Organization
Organization Name:RED MAPLE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WUETHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-387-1992
Mailing Address - Street 1:11017 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:WI
Mailing Address - Zip Code:54441-9020
Mailing Address - Country:US
Mailing Address - Phone:715-387-1958
Mailing Address - Fax:715-387-1992
Practice Address - Street 1:11017 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:WI
Practice Address - Zip Code:54441-9020
Practice Address - Country:US
Practice Address - Phone:715-305-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty