Provider Demographics
NPI:1881414209
Name:GUIDED DISCOVERY LLC
Entity type:Organization
Organization Name:GUIDED DISCOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-642-9716
Mailing Address - Street 1:190 W RIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-7369
Mailing Address - Country:US
Mailing Address - Phone:920-642-9716
Mailing Address - Fax:
Practice Address - Street 1:190 W RIPPLE AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-7369
Practice Address - Country:US
Practice Address - Phone:920-642-9716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty