Provider Demographics
NPI:1972397917
Name:THE GRATEFUL THERAPIST, LLC
Entity type:Organization
Organization Name:THE GRATEFUL THERAPIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN ZEELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:920-850-5746
Mailing Address - Street 1:3331 N CASALOMA DR UNIT 19
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-6500
Mailing Address - Country:US
Mailing Address - Phone:920-850-5746
Mailing Address - Fax:
Practice Address - Street 1:1476 KENWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1134
Practice Address - Country:US
Practice Address - Phone:920-850-5746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health