Provider Demographics
NPI:1902535545
Name:BEECHWOOD THERAPY LLC
Entity Type:Organization
Organization Name:BEECHWOOD THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROUSSEAU-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-280-8599
Mailing Address - Street 1:1470 RIVERS EDGE TRL STE 3
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2755
Mailing Address - Country:US
Mailing Address - Phone:715-832-9292
Mailing Address - Fax:715-832-4172
Practice Address - Street 1:1470 RIVERS EDGE TRL STE 3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2755
Practice Address - Country:US
Practice Address - Phone:715-832-9292
Practice Address - Fax:715-832-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164166518Medicaid