Provider Demographics
NPI:1558119834
Name:PSYCHOLOGICAL AND BEHAVIORAL HEALTH OF THE FOX CITIES, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL AND BEHAVIORAL HEALTH OF THE FOX CITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL PSYCHOLOGIS
Authorized Official - Prefix:DR
Authorized Official - First Name:PHAN
Authorized Official - Middle Name:YEN
Authorized Official - Last Name:HONG-LISHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-915-0696
Mailing Address - Street 1:1331 HOOT OWL CT
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 W FRANKLIN AVE # 351
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2537
Practice Address - Country:US
Practice Address - Phone:920-915-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty