SPIRITED PSYCHOLOGICAL SERVICES LLC


Address: 376 Violet Cir, Grantsburg, WI 54840-8564
Phone: 6126008431

SPIRITED PSYCHOLOGICAL SERVICES LLC (NPI# 1780234955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1780234955
Entity Type Organization
Organization Name SPIRITED PSYCHOLOGICAL SERVICES LLC
Practice Address 376 Violet Cir
Grantsburg
WI 54840-8564
Mailing Address Po Box 502
Grantsburg
WI 54840-0502
Practice Telephone 6126008431
Mailing Telephone 6126008431
Enumeration Date 2019-09-18
Last Update Date 2019-09-18
Authorized Official Name DR. CLARENCE LEONARD BONANDER JR. (OWNER)
Authorized Official Telephone 6126008431
Authorized Official Credential LP
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 251S00000X Community/Behavioral Health Agencies
N 305S00000X Point of Service Managed Care Organizations
Y 261QM0801X Clinic/Center
Specialization: Mental Health (Including Community Mental Health Center)
Ambulatory Health Care Facilities

Office Location

Street Address 376 VIOLET CIR
City GRANTSBURG
State WI
Zip Code 54840-8564

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Taxonomy Information

Taxonomy Code 261QM0801X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Mental Health (Including Community Mental Health Center)

Taxonomy Definition

Definition to come...

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Competitor

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City GRANTSBURG
Zip Code 54840

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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