Provider Demographics
NPI:1588956346
Name:RED FEATHER THERAPY AND CONSULTING, LLC
Entity type:Organization
Organization Name:RED FEATHER THERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STREYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCSW
Authorized Official - Phone:608-738-5261
Mailing Address - Street 1:320 17TH ST S
Mailing Address - Street 2:RED FEATHER THERAPY AND CONSULTING, LLC
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4925
Mailing Address - Country:US
Mailing Address - Phone:608-738-5261
Mailing Address - Fax:608-784-8686
Practice Address - Street 1:2920 EAST AVENUE SOUTH SUITE 101
Practice Address - Street 2:RED FEATHER THERAPY AND CONSULTING, LLC
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4925
Practice Address - Country:US
Practice Address - Phone:608-784-8688
Practice Address - Fax:608-784-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2363-123261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881690386Medicaid