Provider Demographics
NPI:1992957914
Name:PASTORAL & FAMILY THERAPY SERVICES
Entity type:Organization
Organization Name:PASTORAL & FAMILY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LMFT
Authorized Official - Phone:262-473-5005
Mailing Address - Street 1:162 W MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1995
Mailing Address - Country:US
Mailing Address - Phone:262-473-5005
Mailing Address - Fax:
Practice Address - Street 1:162 W MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1995
Practice Address - Country:US
Practice Address - Phone:262-473-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2876-125251S00000X
WI653-124251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health