Provider Demographics
NPI:1184494551
Name:OSHKOSH MARRIAGE AND FAMILY THERAPY CENTER, LLC
Entity type:Organization
Organization Name:OSHKOSH MARRIAGE AND FAMILY THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-479-1996
Mailing Address - Street 1:2211 OREGON ST STE N
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-7001
Mailing Address - Country:US
Mailing Address - Phone:920-479-1996
Mailing Address - Fax:920-479-1997
Practice Address - Street 1:2211 OREGON ST STE N
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-7001
Practice Address - Country:US
Practice Address - Phone:920-479-1996
Practice Address - Fax:920-479-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty