Provider Demographics
NPI:1245951920
Name:CUP OF THOUGHTS THERAPY, LLC
Entity type:Organization
Organization Name:CUP OF THOUGHTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:608-295-4797
Mailing Address - Street 1:310 LANCE DR.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9292
Mailing Address - Country:US
Mailing Address - Phone:608-295-4797
Mailing Address - Fax:
Practice Address - Street 1:310 LANCE DR UNIT 210
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9292
Practice Address - Country:US
Practice Address - Phone:608-400-4320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100030460Medicaid