Provider Demographics
NPI:1811407059
Name:ENIGMA PSYCHOLOGICAL INC.
Entity Type:Organization
Organization Name:ENIGMA PSYCHOLOGICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:715-491-7370
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:FALL CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:54742-0080
Mailing Address - Country:US
Mailing Address - Phone:715-461-7370
Mailing Address - Fax:715-598-6222
Practice Address - Street 1:125 E LINCOLN AVE STE 3
Practice Address - Street 2:
Practice Address - City:FALL CREEK
Practice Address - State:WI
Practice Address - Zip Code:54742-9526
Practice Address - Country:US
Practice Address - Phone:715-491-7370
Practice Address - Fax:715-598-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty