Provider Demographics
NPI:1548088826
Name:AFFIRM PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:AFFIRM PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT CST
Authorized Official - Phone:608-504-2197
Mailing Address - Street 1:5791 IVANHOE CIR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6412
Mailing Address - Country:US
Mailing Address - Phone:608-504-2197
Mailing Address - Fax:608-340-1246
Practice Address - Street 1:2800 ROYAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1518
Practice Address - Country:US
Practice Address - Phone:608-504-2197
Practice Address - Fax:608-340-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty