Provider Demographics
NPI:1992319925
Name:PEACE IN COLORFUL DYNAMICS, LLC
Entity type:Organization
Organization Name:PEACE IN COLORFUL DYNAMICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-659-0078
Mailing Address - Street 1:516 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4863
Mailing Address - Country:US
Mailing Address - Phone:920-659-0078
Mailing Address - Fax:920-779-3146
Practice Address - Street 1:516 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4863
Practice Address - Country:US
Practice Address - Phone:920-659-0078
Practice Address - Fax:920-843-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100040516Medicaid