| Your Genx Therapist Llc | |
|
4539 Woodgate Dr Ste A8 Janesville WI 53546-8205 | |
| (818) 208-4774 | |
| Not Available |
| Full Name | Your Genx Therapist Llc |
|---|---|
| Speciality | Counselor |
| Location | 4539 Woodgate Dr Ste A8, Janesville, Wisconsin |
| Authorized Official Name and Position | Theresa Douglas (OWNER) |
| Authorized Official Contact | 8182084774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Your Genx Therapist Llc 4348 E Pic A Dilly Dr Janesville WI 53546-9681 Ph: (818) 468-8276 | Your Genx Therapist Llc 4539 Woodgate Dr Ste A8 Janesville WI 53546-8205 Ph: (818) 208-4774 |
| NPI Number | 1669211082 |
|---|---|
| Provider Enumeration Date | 05/23/2024 |
| Last Update Date | 03/20/2025 |
| Certification Date | 03/20/2025 |
| Medicare PECOS PAC ID | 7315489838 |
|---|---|
| Medicare Enrollment ID | O20240611003820 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669211082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Theresa A Douglas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376971226 PECOS PAC ID: 7719325141 Enrollment ID: I20240404002466 |
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