Provider Demographics
NPI:1629833348
Name:WHOLEWITHIN WELLNESS
Entity Type:Organization
Organization Name:WHOLEWITHIN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAVILAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC, ICS
Authorized Official - Phone:715-781-1653
Mailing Address - Street 1:2413 MIDDLETON BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2910
Mailing Address - Country:US
Mailing Address - Phone:715-781-1653
Mailing Address - Fax:
Practice Address - Street 1:159 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5820
Practice Address - Country:US
Practice Address - Phone:608-620-5209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)